Category: Clinical Stones: Ureteroscopy
Introduction & Objective : To observe the influence of operating urology post graduate’s level of
skills on the outcome of ureterorenoscopy treatment of ureteral
stones. Ureterorenoscopy was introduced to the clinical practice in
the 1980s and since then it has become a widely accepted and reliable
method for ureteral stone treatment with few complications. Besides
the influence of stone position and size, the efficiency of the
procedure depends on the experience and skill of the operating
urologist. The skill of the operator is listed as a contributing
factor for the ureterorenoscopy success rate. We hypothesized that
operators who have recetly started doing the procedure were less
successful in performing ureterorenoscopy than urologists who have
been doing it for more than a year.
Methods : The study included 100 patients who underwent ureterorenoscopy to
treat ureteral stones at the our center between 2015 and 2017. All
interventions were carried out with a semi-rigid ureteroscope and an
electropneumatic generator used for lithotripsy. The operating
surgeons were divided into two groups. The first group included 3
urologists who had just started post graduate program and the second
group included 3 urologists who had more than one year of experience
doing the procedure.
Results : Radiology tests confirmed that 87% of stones were completely removed
from the distal ureter, 57% from the middle ureter, and 41% from the
proximal ureter. The first group of urologists completed significantly
more procedures successfully, especially for the stones in the distal
(94% vs 78%; P = 0.001) and middle ureter (69% vs 35%; P = 0.002), and
their patients spent less time in the hospital postoperatively.
Conclusions : Recently joined post graduates did not fare as well as their senior
contemporaries in successfully performing ureteroscopy. The fresh candidates had perticularly hard time in managing cases which were previously treated with conservative approach for more than three weeks. These group of clinicians should keep a lower threshold for abandoning the procedure with internal or external drainage in early period of learning curve.
Prarthan Joshi– Senior Resident, Ramaiah Medical College, Bangalore, Karnataka, India