Assessment of Patient and Surgical Variables Including Residency Training Level on Adverse Events After Ureteroscopy for Ureteral Stones: A Multivariate Analysis

Abstract

URS has increased in prevalence in recent years, but overall complication rates are low. Resident level of experience does not appear to impact adverse event rate. Stone clearance during initial surgery appears to be the most important in avoiding adverse events. Further expansion of the database over time will improve our ability to predict adverse outcomes in this common procedure.

One‐surgeon basketing technique for stone extraction during flexible ureteroscopy for urolithiasis: A comparison between novice and expert surgeons

“…However, in the present study, the stone-free rate achieved by the inexperienced surgeons was 92%, which is comparable with other reports. 12,15 The total complication rate, including ureteral injury and ureteral stenosis, was 8% in the present study, which compared well with those of previous studies, [16][17][18] and particularly well with recently published guidelines, which reported the overall complication rate after f-URS as 9-25%. 16 According to these guidelines, most complications are minor and do not require intervention, and ureteral avulsion and stricture are rare (<1%).…”

“…7 However, the risk of poor stone clearance rates with this technique has been shown to be significant, increasing the likelihood of an adverse event. 12 It has been reported that approximately 20% of patients with residual stone dust or fragments ≤4 mm experience emergency visits within 5 years after f-URS. 13,14 Therefore, it is important to extract stone fragments as thoroughly as possible in f-URS.…”

“…The +2 (À20 to +25) +2 (À18 to +32) 0.59 Hemoglobin change (g/dL) À1.0 (À2.5 to +0.7) À0.7 (À2.0 to +0.9) 0.91 White blood cells change (10 3 /lL) +1800 (À1900 to +13 000) +1200 (À4200 to +10 000) 0. stone-free rate was reported to be 92-95% in patients operated on by surgeons in their first 6 years postgraduate. 12,15 The stone-free rate might vary depending on the stone size and stone position. Furthermore, as the definition of stonefree rate is not standardized, it is not possible to simply compare surgical results.…”

“…Studies have shown that patients who had residual stones remaining after f-URS were more likely to experience postoperative events. 12 Thus, to ensure low postoperative complications, it is imperative not to leave residual fragments. The one-surgeon basketing technique might help to reduce residual fragments after f-URS, thereby reducing the rate of postoperative complications.…”

Correlation of Operative Time with Outcomes of Ureteroscopy and Stone Treatment: a Systematic Review of Literature

“…It may seem intuitive for increased surgeon experience correlating with a decreased operative time; however, there is limited evidence to suggest that this decreased complication rates [45,46]. Wolff et al found that specialist urologists had a lower operative time and complication rate; however, neither of these were statistically significant [20].…”