Trends in endourologic practice laparoscopic partial nephrectomy

Background and Purpose: With continuing rapid changes in endourology, we conducted a new survey of practice trends and expanded our sampling to include non-American urologists. Materials and Methods: The survey was done via the Internet using the database for the 2003 World Congress of Endourology. Approximately 1100 surveys were sent, and responses were received from 193 urologists, who had been in practice for a mean of 9.9 years (median 8 years). Of these, 52% spend > 50% in endourology, and 48% devote > 20% of their practice to laparoscopy. Results: More than half of the respondents (56%) perform laparoscopic partial nephrectomy (LPN), and 65% chose LPN as the procedure of choice for patients with an uncomplicated 3-cm renal mass. The majority obtain vascular control, most commonly by clamping the renal artery only. Most respondents do not use ureteral stents unless the collecting system is entered. Conclusions: These results and a review of the literature indicate a growing acceptance among endourologists of LPN as the procedure of choice for patients with small renal masses who are to undergo nephronsparing surgery. Disagreement remains concerning the role and type of vascular control, the use of hemostatic agents, and the value of stents when the collecting system is entered.