Frequency of endourological procedures and application of new technologies in Turkey: Results of an questionnaire-based study

Türkiye'de endoürolojik uygulamaların sıklığı ve yeni teknolojilerin kullanımı: Anket çalışması sonuçları

Uğur KUYUMCUOĞLU,Osman METİN,Erkan ERBAY,BİLAL ERYILDIRIM,Necmettin PENBEGÜL

Abstract

Introduction: While deciding on the method of treatment for urinary system stone disease and BPH, patient and disease characteristics as well as surgeons' individual preferences play a major role. In this study the interests of urologists and the subjects they need to be trained on besides their preferences on treatment of BPH and urinary system stones and the frequency of using new technologies are investigated. Materials and Methods: In this questionnaire-based study performed between September 2003-May 2004 question forms were handed or posted or faxed. Overall in Turkey, 336 questionnaires were assessed. Results were evaluated separately according to the geographical region in which urologists had been working, their speciality durations, the institution they had obtained their speciality and the one they were already working as staff. Results: At the end of assessment, the subject urologists were mostly interested in was found to be "Endourology" with 69.9% which was followed by "Urooncology" with 42.5%. Interestingly, due to the evaluation done according to the specialty duration, "Endourology" maintained to occupy the first rank. The first two preferences of the urologists working in the university clinics and educational hospitals were "Endourology" and "Urooncology" with similar rates while "Endourology" was number one with 83.2% in service hospitals. In the study, 32.7% of the urologists expressed desire to be trained in laporoscopic surgery while 25% stated that they did not have to be trained in any subject. Regarding the questions on the treatment of urinary system stones, ESWL was the most preferred method of treatment for urinary system stones with 53.6%. Open surgery was selected for only 19.4% of the cases and the region it was most intensely performed (32.6%) was South-East Anatolia. University hospitals were the treatment sites that use endourological therapy most widely (35.6%) while this rate was only 15.2% in service hospitals. According to the results, it was determined that the urologists included in this study applied medical treatment in 70.8%, TUR in 18.8% and open surgery in 8.4% of BPH cases and the most preferred alternative minimal invasive treatment method was holmium laser with 54.4%. TUR was in the first rank with 64.2% for the surgical therapy of BPH and open surgery was the second preferred one. Middle Anatolia region was the one TUR was most intensely performed (70.5%) while Mediterranean region was the one open surgery was most widely preferred (43.1%). It was determined that open surgery preference slightly increased in the urologists with more than 10 years speciality duration (33.2%). TUR was on the first rank with 79.3% in university hospitals. Conclusion: We believe that this questionnaire-based study will light the way for the training and planning efforts based on the establishment of deficiencies and goals in urology.

Özet

Üriner sistem taş hastalığı ve BPH tedavisinde yöntem seçiminde hasta ve hastalığın özelliklerinin yanı sıra cerrahın kişisel tercihleri de önemli rol oynamaktadır. Bu çalışmada ankete katılan ürologların ilgi alanları ve eğitim ihtiyacı duyulan konular ile BPH ve üriner sistem taşlarının tedavisindeki tercihleri ve yeni teknolojileri kullanım sıklığı araştırıldı. Eylül 2003-Mayıs 2004 tarihleri arasında yapılan anket çalışmasında anket formları elden, posta ve faks yolu ile dağıtıldı. Türkiye genelinde 336 anket formu değerlendirmeye alındı. Sonuçlar; ürologların bulunduğu coğrafi bölge, uzmanlık süresi, uzmanlık eğitimini aldıkları ve çalıştıkları kuruma göre ayrı ayrı değerlendirildi. Değerlendirme sonunda en çok ilgi duyulan bölüm %69,9 ile "Endoüroloji" olarak belirlenirken, "Üroonkoloji" %42,5 ile ikinci sırada yer aldı. Ankete katılan ürologların %32,7'si "Laparoskopik Cerrahi" konusunda eğitim almak istediklerini ifade ederken, %25'i ise her hangi bir konuda eğitime ihtiyaçları olmadığı görüşünde idiler.Ürologların, tüm BPH olgularının %70,8'inde medikal tedavi uyguladıkları, %18,8'inde TUR ve %8,4'ünde ise açık cerrahi yöntemi tercih ettikleri, en çok rağbet gören alternatif minimal invaziv tedavi yönteminin ise %54,4 ile holmium lazer uygulaması olduğu belirlendi. Üriner sistem taşlarının cerrahi tedavisinde ESWL'nin %53,6 ile en çok tercih edilen yöntem olduğu, açık cerrahi yönteme ise olguların sadece %19,4'ünde başvurulduğu belirlendi. En sık kullanılan intrakorporeal litotriptörün ise %67,9 ile pnömotik litotriptör olduğu tespit edildi. Yapılan bu anket çalışmasının ürolojideki eksiklik ve hedeflerin tespiti ile yapılacak eğitim ve planlama çalışmalarına ışık tutacağı inancındayız.