O2218: Practice Patterns and Attitudes on Collaboration in Pediatric Renal Mass Surgery

Background: There is overlap in the management of pediatric renal masses between pediatric urologists and pediatric surgeons. Our objective was to evaluate the perspectives and practices of both specialties in the management of renal mass cases. We hypothesized that there would be variability in attitudes toward management and collaboration both within and between specialties.

Methods: A 33-field survey was distributed to Societies for Pediatric Urology (SPU) and American Pediatric Surgical Association (APSA) members covering demographics, training experience, renal mass management, and attitudes on interdisciplinary collaboration. Non-parametric, descriptive statistics were used to evaluate survey data. For comparison of categorical variables, the Pearson’s chi-square test was performed.

Results: The survey was sent to 1,237 APSA and 404 SPU members, with 130 responses (64 urologists/66 surgeons). Most respondents were male (64%) and between 41-50 years of age (45%). Most (66%) practiced in urban settings and at academic institutions (83%). On average, pediatric urologists performed more renal mass cases as residents (51-100 urologists vs 1-5 pediatric surgeons; p< 0.001) while pediatric surgeons performed more cases as fellows (11-30 pediatric surgeons vs 1-5 urologists; p< 0.001). Overall, 87% of respondents perform < 5 renal mass cases annually. While 73% report collaboration on at least some cases, perspectives on roles differed by specialty. Pediatric surgeons were more likely to report a clear understanding of each surgeon’s role during cases (p < 0.001), while pediatric urologists more often indicated that they must actively advocate for their involvement (p < 0.001). Respondents noted pediatric urologists perform majority (>50%) of robotic/minimally invasive partial nephrectomies (40%; n=51), while pediatric surgeons primarily manage open radical nephrectomies (83%; n=107). Despite most respondents indicating that collaboration is warranted for open partial nephrectomy (61%), bilateral (63%), and solitary kidney cases (53%), 41% reported no formal coordination between specialties. Pediatric surgeons were more likely to participate in multidisciplinary tumor board compared to pediatric urologists (98% vs. 66%; p< 0.001). Overall, 91% of respondents agreed that pediatric renal masses are managed in accordance with oncologic standards at their institution.

Conclusion: There is significant variability in surgical responsibility and the perceived need for collaboration between specialties in pediatric renal mass cases, although most support collaboration in at least some scenarios. A more rigorous investigation is needed to determine the optimal approach to management for the best patient outcomes.