Training in ureteroscopy: a critical appraisal of the literature

Abstract

What’s known on the subject? and What does the study add? Ureteroscopy outcome depends on the availability of the technological equipment and the surgeon experience. This study tries to define the learning curve of ureteroscopy, to underline the current quality of training and to propose the minimum requirements for a curriculum in ureteroscopy. The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence‐Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high‐volume stone centres may be the key to optimizing URS training.

The effect of ureteroscope size in the treatment of ureteral stone: 15-year experience of an endoscopist

“…According to a meta-analysis study, [19] which was investigated learning curve of URS, to increase stone-free rate and reduce severe complications, it was necessary for the surgeon to have performed more than 50 cases in a high-volume center. Therefore, the center which was conducted the current study has a high-volume center for the treatment of ureteral stones since 1990s and an endoscopist had gained surgical competence for this procedure at the beginning of the study.…”

Evaluation of ureteroscopy outcome in a teaching hospital

“…Some studies revealed unfavorable outcome with larger stone size [6,7,16] , while others didn't show significant effect on outcome. [8,17] In this study, a mean stone width ± SD of 9.9±4.3 mm and length 10.5±4.6 were found to be the only significant factors in the univariate analysis but they didn't maintain their significance in the multivariate analysis.…”

“…A literature review by Skolarikos et al certifies the presence of obstacles in defining the learning curve in URS. [17] In a study done by Botoca et al [23] it was found that URSs performed by trainees were associated with lower stone-free rates and higher complication rates. However, after approximately 50 procedures, URSs done by trainees showed a tendency to plateau at a level similar to the results mentioned in the EAU guidelines.…”

“…The ACGME [17] assigned a minimum number of procedures as part of the accreditation process for urology residency programs. Three categories exist and include surgeon, teaching assistant, and the first assistant.…”

Novel Ureteroscopic Navigation System with a Magnetic Tracking Device: A Preliminary Ex Vivo Evaluation

“…Ureteroscopic procedures are complex, and considerable experience is necessary to acquire the fundamental skills needed. 9 Pyelocaliceal phantoms are commonly used for training and assessment of ureteroscopic skills using inanimate bench models (Scope Trainer; Medskills Ltd., Edinburgh, UK and Uro-Scopic Trainer; Limbs and Things, Bristol, UK). Studies using these bench models found that urologists highly experienced in flexible ureteroscopy clearly had better skills than novice surgeons.…”