Treatment of patients with small renal masses: a survey of the American Urological Association

Abstract

Purpose: We surveyed American Urological Association members to determine factors that influence the treatment of patients with small renal masses.

Materials and methods: In June 2009 American Urological Association members were solicited to complete an online survey. Respondents were asked their preferred treatment for 8 cases and 3 index patients. In each case computerized tomographic axial and schematic coronal images were provided.

Results: A total of 759 active urologists with varied training backgrounds and clinical practice settings completed the survey. Tumor size (OR 8.4, 95% CI 7.1-10.1), tumor depth (OR 19.2, 95% CI 14.8-25.0) and tumor location (OR 24.0, 95% CI 18.1-31.8) were markedly associated with preference for radical nephrectomy instead of partial nephrectomy. Fellowship trained urologists (OR 0.4, 95% CI 0.2-0.6) and urologists at academic hospitals (OR 0.6, 95% CI 0.4-0.9) were less likely to choose radical nephrectomy. Respondents were more likely to choose active surveillance in an older patient (OR 2.7, 95% CI 2.1-3.6) or in a patient with comorbidities (OR 10.0, 95% CI 8.0-12.4). Urologists were less likely to choose active surveillance for a 4 vs 2 cm tumor (OR 0.18, 95% CI 0.15-0.21). Active surveillance was chosen more often if the tumor was perihilar vs mid kidney (OR 2.0, 95% CI 1.8-2.3) or polar (OR 2.1, 95% CI 1.9-2.5).

Conclusions: There is considerable heterogeneity in the treatment of patients with clinical T1a tumors. Several factors explain these differences as selected treatments are independently associated with tumor, patient and urologist factors.