Laser access and utilization preferences for pediatric ureteroscopy: A survey of the Societies of Pediatric Urology

Abstract

Introduction: We sought to evaluate laser access and practice variability for pediatric ureteroscopy (URS) across the Societies of Pediatric Urology (SPU) to identify opportunities and barriers for future technology promulgation and evidence dissemination. Methods: A 25-question survey was sent electronically to members of the SPU. The questionnaire assessed surgeon and hospital characteristics, treatment preferences based on an index case, and information about available laser units. Descriptive and comparative statistical analyses were performed to assess patterns of care and laser accessibility across the SPU. Results: A total of 105 of 711 (15%) recipients responded. Seventy-seven respondents (73%) reported laser ownership, which was associated with greater after-hours laser access (87% vs. 13%, p<0.01). Fifty-eight individuals provided additional laser specifications, of whom 21 (36%) used a high-power laser unit (>60 W). Standard-power lasers were used more frequently in free-standing children’s hospitals, as compared to those working within a larger hospital complex (75% vs. 50%, p=0.049). Variation existed in treatment preferences with respect to dusting (33, 34%), fragmentation (18, 19%), or a hybrid approach (46 respondents, 48%). Stone clearance was the most important consideration irrespective of treatment choice. Conclusions: Variability in surgical preferences and accessibility to laser units exist across pediatric urologists who performing URS. Laser ownership and access to newer technologies vary across practices and may influence treatment options. Understanding access to laser technology will be important when considering opportunities for surgical optimization to improve patient outcomes through future studies.

Paediatric Ureteroscopy (P-URS) reporting checklist: a new tool to aid studies report the essential items on paediatric ureteroscopy for stone disease

“…Therefore, providing this information e.g. start-up settings adds to the body of knowledge on the topic [ 15 ]. The same applies for additional information, such as laser activation time and total laser energy.…”

Ureteroscopy for stone disease in the paediatric population: lessons learned and outcomes in a Nordic setting

“…10,11 There exist a range of practice patterns and areas of debate in paediatric URS, such as the role of elective and planned pre-operative stenting prior to definitive stone treatment, use of ureteral access sheath (UAS) and optimal followup regimes. [12][13][14][15][16] Most published reports originate from a relatively small pool of nations with large population sizes (Figures 1 and 2). 8,9,[17][18][19][20] Outcomes from smaller nations remain under-reported.…”