Diversity in urologists' personal preferences in the ureteroscopic management of ureteral calculi in Norway.

Objective: The aim of this study was to evaluate diversities in Norwegian urologists' personal preferences in the endoscopic management of ureteral calculi.

Material And Methods: A questionnaire exploring different items of importance for the ureteroscopic management of ureteral calculi was sent to the 124 specialists and residents in urology at the 24 hospitals treating urolithiasis endoscopically in Norway.

Results: A total of 92 physicians answered the questionnaire (response rate 74.2%), representing 23 of the 24 hospitals. A median of 53 (range 5-254) ureteroscopies was performed per year for ureteral calculi at each institution. Five institutions used antibiotic prophylaxis as a routine according to consistent regimes. Shockwave lithotripsy was considered first choice treatment for calculi in the upper ureter by 47.8% of the physicians. A safety guidewire (SGW) was routinely inserted alongside the ureteroscope by 79.3% of the physicians, while the rest employed an SGW only in complicated cases. After laser lithotripsy 81.3% of the physicians left small fragments in situ for later spontaneous passage. JJ stents or external ureteral catheters were always inserted postendoscopically by 47.3% of the physicians and restricted to special cases by 52.7%. Postendoscopic control was completed at a maximum of 4 weeks by 31.4% of the physicians, and at 12 weeks or later by 24.4%.

Conclusions: Variations in the urologists' personal preferences found in this study may negatively influence the outcome for patients. A greater degree of consensus is needed and should be a task for both the central authorities and the local urologists.