In PSD, guideline [11] strongly recommends direct radiography (DG) and US as primary for diagnosis and follow-up. In line with the guidelines, urologists preferred US the most. However, contrary to expectations, DG was less preferred. IVP was not chosen, indicating that urologists had abandoned this diagnostic modality. We think that CT without contrast should be selected in preoperative patients. We know that CT provides good anatomical information and has high specificity. However, some studies [12, 13] in the literature recommend CT as the first diagnostic method for PSD because it is the gold standard diagnostic method. Radiation is a major problem for pediatric patients. Therefore, US should be performed first, at least to determine urgent conditions such as hydronephrosis and pyonephrosis. This way, pediatric patients will be protected from radiation exposure in non-emergency situations. For children for whom non-contrast CT is planned, it is also strongly recommended in guideline [11] that CT should be low dose. Urologists should consider this recommendation and prefer low-dose, non-contrast CT in children.
In general, URS is the most commonly used surgical method in PSD because it is easily accessible to most urologists and minimally invasive. EAU guidelines [11] recommend PCNL for kidney stones larger than 2 cm. Participants work in the field following the guideline recommendations. In staghorn kidney stones, mini PCNL is performed more frequently in patients aged 0–2 and 2–6 years because the kidney is relatively smaller. Between the ages of 6 and 18, standard PCNL is preferred more frequently as the kidney approaches adult size. In addition, although AUA (American Urology Association) guidelines [10] states that SWL can be performed in pediatric patients for stones larger than 20 mm, a ureteral catheter (Double J) or percutaneous nephrostomy should be placed before the procedure. Since this method requires extra intervention in pediatric patients, it has not been a preferred treatment method. The fact that the surgical treatment of staghorn kidney stones can be performed regardless of the place of duty and title shows that the experience of urologists in Turkey is similar.
In the literature, stone-free rates ranging from 57–97% in the short term and 57–92% in the long term after SWL are available [9, 14, 15]. Following guideline [11] recommendations, symptomatic pelvic stones less than 10 mm in diameter are treated with SWL in all age groups, with the endourological method (RIRS and PCNL) being the second most common treatment modality. We can conclude that urologists who prefer RIRS as the first treatment method do not have the opportunity to perform SWL or cannot perform SWL due to contraindications. The fact that SWL requires anesthesia in pediatric patients is a relative disadvantage.
Recent guidelines [11] recommend SWL / PCNL / RIRS as the first choice of surgical treatment for 10–20 mm pelvic stones. SWL is more likely to require more than one session. For this reason, we believe that mini PNL is the first preferred method among the participants. RIRS was chosen as the second method of choice. The aim is to make patients stone-free with the minimum number of sessions possible.
Although observation or SWL is recommended as the first choice for lower pol stones smaller than 10 mm in the recently published guideline [11] the participants used SWL as the first choice and RIRS as the second choice only between 2 and 6 years of age. In other age groups, RIRS was preferred most frequently. We know that the success of SWL is lower in lower pole stones than in different localizations due to the location. For this reason, the participants may prefer RIRS instead of SWL.
In previous studies, the stone-free rate with URS ranged between 82–100% [16, 17]. However, endoscopic surgery via the retrograde route is relatively more complex in upper ureteral stones. Middle and lower ureteral stones can be removed relatively more easily with URS. Participants reported URS as their first choice for symptomatic ureteral calculi in all age groups. However, guideline [11] recommends SWL as the first-line treatment for upper ureteral stones.
There are 3 different methods for the surgical treatment of bladder stones: endoscopic (transurethral/percutaneous), SWL, and open surgery. Guidelines [11] recommends that endoscopic methods should be preferred primarily. Participants frequently preferred endoscopic methods following guideline recommendations and in their daily practice.
The fact that there is a statistical difference in stone analysis according to the place of duty is due to the inadequacy of state hospitals in terms of facilities. The conditions of state hospitals should be improved. The fact that stone analysis and metabolic screening are independent of the title shows that urologists perform stone analysis when they have sufficient facilities.
US, which is not as effective as computed tomography in stone detection, is preferred as a postoperative control imaging method because it is easily accessible to urologists, does not contain radiation, and provides reliable information about the condition of the collecting system.