Presented by: Micah Levy
Icahn School of Medicine at Mount Sinai

Introduction

Studies have shown that surgeon experience, as determined by both case volume and endourology fellowship training significantly impact surgical outcomes for ureteroscopy (URS). We analyzed the differences in surgical outcomes of URS performed by high volumes urologists with and without endourology fellowship training.

Materials

Patients receiving URS for stone management from a high-volume urologist (> 50 URS per year) at our institution between 2017 -2019 were retrospectively reviewed. Demographics, stone characteristics, and surgical outcomes including stone free rate (SFR), complications, and imaging follow up were recorded. Analysis compared outcomes of those high-volume urologists with endourology fellowship training (FT) and those without (NFT).

Results

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581 cases performed by 6 high-volume urologists (FT: 3, NFT: 3) were reviewed. Compared to FT urologists, those that were NFT operated on older patients (61 vs. 57, p = 0.001), a higher rate of patients with American Society of Anesthesiology (ASA) score of III/IV (38.28% vs. 26.50%, p = 0.016), patients with statistically significant but clinically insignificant larger primary stone sizes (0.8 cm vs. 0.7 cm, p = 0.001) and total stone burden (1.1 cm vs. 0.8 cm, p = 0.002), and patients with a higher rate of prior stenting (39.62% vs. 22.29%, p = 0.010) and prior failed stone procedures (21.09% vs. 13.36%, p = 0.045). However, FT urologists had a significantly higher SFR for primary (90.10% vs. 75.00%, p < 0.001) and secondary stones (91.29% vs. 80.95%, p = 0.023). They also had fewer total complications (3.75% vs. 13.28%, p < 0.001) though there was no difference in reoperation rates (5.52% vs. 4.69%, p = 0.827). While FT complications were all Clavien-Dindo (CD) I/II, the difference in CD III/IV rates was not statistically significant (0.00% vs. 17.65%, p = 0.227). Lastly, though there was no difference in the rate of 365-day imaging follow up (63.58% vs. 65.62%, p = 0.747), FT patients had a higher rate of imaging follow up within the recommended 90-day post-operative period (65.92% vs. 41.46%, p < 0.001).

Conclusion

Even amongst high-volume urologists, those with endourology fellowship training had improved surgical outcomes compared to those without fellowship training, suggesting that fellowship training may provide an added expertise that case volume alone does not. 

Funding

Partial funding by the Endourology Society Summer Scholarship awarded to Micah Levy. 

Co-Authors

Daniel Wang,
Icahn School of Medicine at Mount Sinai

Christopher Connors,
Icahn School of Medicine at Mount Sinai

Aaron Walt,
Icahn School of Medicine at Mount Sinai

Jacob Stifelman,
Icahn School of Medicine at Mount Sinai

Olamide Omidele,
Icahn School of Medicine at Mount Sinai

Francisca Larenas,
Icahn School of Medicine at Mount Sinai

Michael Palese,
Icahn School of Medicine at Mount Sinai