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- Title
Impact of surgeon's experience on outcome parameters following ureterorenoscopic stone removal.
- Authors
Wolff, I.; Lebentrau, S.; Miernik, A.; Ecke, T.; Gilfrich, C.; Hoschke, B.; Schostak, M.; May, M.; BUSTER study group; Baars, Andreas; Balsmeyer, Ulf; Burger, Maximilian; de Boer, Matthias Claas; Danzer, Gerhard; Enzmann, Thomas; Fahlenkamp, Dirk; Filter, Sebastian; Fritsche, Hans Martin; Hallmann, Steffen; Hebert, Joachim
- Abstract
Within the BUSTER trial, we analyzed the surgeon's amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01–04/2015. Surgeon's experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien–Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon's experience had no significant impact on the complication rate. We observed no differences in this study's main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists' stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists' more than two-fold higher stone-free rate compared to residents' justifies ongoing efforts to establish structured URS training programs.
- Subjects
PERCUTANEOUS nephrolithotomy; SURGEONS; URINARY calculi; URETEROSCOPY; MULTIVARIATE analysis; KIDNEY surgery; CONTENT analysis
- Publication
Urolithiasis, 2019, Vol 47, Issue 5, p473
- ISSN
2194-7228
- Publication type
Article
- DOI
10.1007/s00240-018-1073-7