Gender Differences Among Urologists in the Assessment and Utilization of ESWL Treatment: Insights from a Multinational Survey of 3747 Participants

Background/Objectives: This study aimed to examine gender-associated differences in extracorporeal shock-wave lithotripsy (ESWL) utilization as well as urolithiasis diagnostic evaluation, treatment strategy, and follow-up across a multinational sample of urologists and trainees. Methods: A multinational cross-sectional survey of members of the Société Internationale d’Urologie (SIU) was conducted from June to July 2022 in seven languages. The survey was completed by 3747 urologists and trainees (283 female and 3464 male respondents) from 108 countries. To reduce baseline differences, propensity-score matching was performed with exact matching on years of clinical practice, continent, and career stage, yielding a matched cohort of 1191 respondents (279 female and 912 male). Categorical comparisons used Cochran–Mantel–Haenszel analyses stratified by a matched-set identifier, and 0–10 scored items were compared using stratified Wilcoxon rank-sum analyses with the matched set as the stratum. Results: In the matched cohort, annual procedural-volume distributions differed by gender for ureterorenoscopy (URS) (p = 0.0009), open surgery (p = 0.002), laparoscopy/robotics (p = 0.010), and percutaneous nephrolithotomy (PCNL) (p = 0.018), whereas ESWL volume did not differ significantly (p = 0.077). Among ESWL-specific categorical practices, coupling-gel use differed by gender (p = 0.029), while alpha-blocker use, antibiotic prophylaxis, JJ-stent use, stone-fragment collection, ESWL-machine type, and operator did not. Among the 851 respondents that completed the 0–10 practice items (186 female, 665 male), urine-culture assessment (8.4 vs. 7.6; p = 0.030), complete blood count (8.0 vs. 7.5; p = 0.047), and repeating ESWL within 7 days (2.5 vs. 3.4; p = 0.048) showed nominal gender-associated differences. The majority of other scored items were similar, including computed tomography (CT) urography (p = 0.055). Because these analyses were exploratory and no multiplicity adjustment was applied, nominally significant findings should be interpreted as hypothesis-generating. Conclusions: In this multinational survey of SIU members, most self-reported ESWL-specific practices were similar between female and male respondents after matching on key demographic, geographic, and professional characteristics. Gender-associated differences were observed in procedural-volume distributions as well as a limited number of reported assessments and procedural items. These findings are exploratory associations rather than causal effects of gender and may reflect measured and unmeasured professional, institutional, geographic, and training-related factors.