Canadian urologist artoon1/30/2024 ![]() Responses were anonymous and no personal information was collected or stored. The survey questions were formatted as short answer, multiple choice, or Likert rating scale questions. All items were then revised according to the feedback received in the pilot survey. Following approval from the CIUSSS de l’Estrie - CHUS Research Ethics Board, a pilot questionnaire was developed and tested among 20 urologists in October 2018. This is a descriptive cross-sectional study using electronic surveys and conducted based on known guidelines. We also aimed to characterize patient and disease factors associated with use of active surveillance and triggers used as criteria for intervention. The objectives of this survey study were to characterize the use of active surveillance in the management of complex renal cysts in Canada and to elicit the perceived barriers to adoption. However, the adoption of this treatment strategy for the management of complex cysts in Canada and the criteria used by urologists as triggers for discontinuation of surveillance and intervention have yet to be defined. Recent observational data has provided support for the use of active surveillance among patients with complex renal cysts. Thus, active surveillance has been proposed as an alternative to surgery. However, similar to small non-cystic renal masses, there is growing evidence suggesting that most of these cysts are indolent and unlikely to metastasize. Bosniak III and IV cysts have a high risk of malignancy (40–60% and 80–90%, respectively) and have traditionally been managed with surgical excision. Cystic renal cell carcinoma represents approximately 5–10% of all renal malignancies. Renal cysts are classified according to the Bosniak classification, which categorizes the cysts according to their degree of complexity and risk of malignancy. Up to one third of individuals over 60 years of age will be diagnosed with a renal cyst following abdominal imaging. High-quality studies are required to better define the benefits and risks of cystic renal mass surveillance. Practice patterns are heterogeneous among those offering surveillance. Conclusionsĭespite active surveillance being included as a management option in guidelines, many Canadian urologists are reluctant to offer surveillance to patients with Bosniak III or IV cysts. The most commonly reported barriers to a greater adoption of surveillance were concerns regarding its oncologic safety, the lack of data to support surveillance in this population, and the lack of triggers for discontinuation of active surveillance and intervention. ![]() ![]() A significantly greater proportion of academic urologists, compared to non-academic urologists, viewed surveillance as a management option for patients with a Bosniak III or IV cyst. Only 13.7% of respondents reported never or rarely ( 50% of cases. A large proportion of respondents (33.1%) offered active surveillance in > 50% of cases. Management of Bosniak III cysts varied considerably. MethodsĪ web-based survey was sent to all registered, active members of the Canadian Urological Association ( N = 583) in October 2018. The main objective of this study was to characterize the use of surveillance in the management of complex renal cysts. However, growing evidence suggests that many can be managed by active surveillance. Bosniak III and IV cysts have a high risk of malignancy and have traditionally been managed surgically.
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