Survey of 69 urologists finds APPs handle stone prevention in ~half of U.S. practices, with half those practices reporting no formal physician oversight
Journal: Urolithiasis | Published: 2026-03-05 | Type: Survey/Cross-sectional | PMID: 41784813 Authors: Smith LJ, James E, Santos E, Lukas VA, Wollin DA, Sobel DW (Maine Medical Center; Brigham and Women's Hospital) Funding/COI: Funding not disclosed. Authors declare no competing interests. IRB exempt.
A 12-question survey of Endourological Society members finds that 49.3% of respondents use advanced practice providers (APPs — nurse practitioners and physician assistants) in kidney stone prevention clinics, with U.S.-based practices far more likely to do so than international peers (76.3% vs. 16.1%). APPs are performing substantive clinical tasks — interpreting metabolic labs, managing medications, reviewing imaging — and in half of practices, doing so without any formal physician oversight structure. With a 17% response rate from a subspecialty society, this is a snapshot of academic urology, not a representative count of the field.
This is a descriptive survey with 69 responses out of 413 distributed — a 17% response rate. Endourological Society membership skews academic and subspecialty-trained, which almost certainly inflates APP utilization figures relative to community urology practice. The survey is cross-sectional and self-reported; it cannot establish why APPs are or aren't being used, and it contains no outcome data whatsoever — stone recurrence, patient satisfaction, and adverse events are all unaddressed.
The OR for fellowship training (3.11) came from univariate analysis only. When restricted to the U.S. cohort, it evaporated (OR 2.40, P = 0.300) — a textbook sign of confounding, likely driven by structural differences between U.S. academic practice and international settings rather than any direct effect of fellowship training.
A small survey from a subspecialty society where the 17% response rate alone should temper most conclusions. The most interesting finding — that half of APP-using practices operate without formal oversight structures — is the one the paper is least equipped to interpret, because it collected no data on whether that gap matters clinically. This is a needs-assessment paper in practice-pattern clothing. File it under "this is happening, someone should study it properly," not under evidence.