67th Annual Meeting Abstracts
Does Practice Environment Affect the Management of Small Renal Masses?
Vanessa L Elliott, *Paul H Smith, Jay D Raman
Penn State Hershey Medical Center, Hershey, PA
Introduction: Renal preservation strategies have historically been underutilized when managing small renal masses (SRMs). We evaluated contemporary practice patterns for the management of SRMs in the context of urologist’s practice environment.
Materials & Methods: A survey instrument querying practice type (private vs. academic/academic affiliation) and management of three case scenarios (SRM in a healthy 55 year old, healthy 75 year old, and comorbid 75 year old patient) was distributed to attending physicians of the Mid-Atlantic American Urological Association (MA-AUA).
Results: Of the 287 responding urologists who managed kidney cancer, 92 (33%) practiced in an academic environment, and 189 (67%) were private practitioners. For SRMs in a healthy 55 year old, private practice physicians were more likely to perform a radical nephrectomy (5% vs. 0%, p=0.03) and less likely to perform a partial nephrectomy (82% vs. 91%, p=0.04) when compared to those in an academic environment. Management of SRMs in a comorbid 75 year old patient was similar irrespective of practice type with over 80% of urologists selecting ablative or surveillance strategies. Interestingly, for SRMs in a healthy 75 year old patient, private practitioners were less likely to choose surveillance strategies than academic physicans (1% vs. 14%, p=0.001).
Conclusions: Although urologists responding to this survey largely espouse renal preservation treatments, private practitioners are still more likely to perform a radical nephrectomy for SRMs. Surveillance has become a mainstream management for SRMs in the elderly, comorbid patient; interestingly, this strategy is infrequently employed by private practitioners for older, but healthy, patients.
