Feasibility Drives Adoption of Volumetric Stone Measurement: Results from an International Survey

Introduction: Accurate assessment of stone burden is essential for clinical decision-making in urolithiasis. Although stone volume is considered a more accurate representation of stone burden than maximal diameter, most clinical practice continues to rely on linear measurements. The extent to which volumetric assessment is used in daily practice remains unclear. Therefore, this study aimed to evaluate current global practices in stone burden assessment and identify factors associated with the adoption of volumetric measurement. Materials and Methods: An international cross-sectional survey was conducted among practicing urologists. The questionnaire was distributed electronically to members of the Endourological Society, the European Association of Urology Endourology Section, and national urological societies across Latin America, Africa, and Oceania. The survey assessed preferred methods for stone burden measurement, perceived barriers to volumetric assessment, and willingness to adopt automated measurement tools. Multivariable logistic regression analysis was performed to identify predictors of volumetric measurement use. Results: A total of 252 urologists participated in the survey. Respondents were distributed across South America (32.9%), Europe (25.4%), North America (21.0%), Asia (9.9%), Central America (5.2%), Africa (5.2%), and Oceania (0.4%). Most respondents relied primarily on maximal stone diameter for clinical decision-making, although 51.6% reported incorporating volumetric assessment selectively depending on the clinical scenario. In multivariable analysis, perceived feasibility of volumetric assessment was the strongest predictor of volumetric measurement use (odds ratio [OR] 3.95, 95% Confidence Interval [CI] 2.28–6.86; p < 0.001), followed by academic practice (OR 1.87, 95% CI 1.03–3.38; p = 0.040). Fellowship training and years in practice were not independently associated with volumetric adoption. Conclusions: Despite increasing evidence supporting volumetric assessment, its use in routine clinical practice remains limited worldwide. Improving feasibility through automated or integrated measurement tools may facilitate broader adoption.