title: Ureterorenoscopic treatment of ureteral stones--influence of operator's experience and skill on the procedure outcome.
abstract: OBJECTIVE
  To observe the influence of operating urologist's education and adopted skills on the outcome of ureterorenoscopy treatment of ureteral stones.
  
  
  METHODS
  The study included 422 patients (234 men, 55.4%) who underwent ureterorenoscopy to treat ureteral stones at the Urology Department of Clinical Hospital Center Split, Croatia, between 2001 and 2009. All interventions were carried out with a semi-rigid Wolf ureteroscope and an electropneumatic generator used for lithotripsy. The operating specialists were divided into two groups. The first group included 4 urologists who had started learning and performing endoscopic procedures at the beginning of their specialization and the second group included 4 urologists who had started performing endoscopic procedures later in their careers, on average more than 5 years after specialization.
  
  
  RESULTS
  Radiology tests confirmed that 87% (208/238) of stones were completely removed from the distal ureter, 54% (66/123) from the middle ureter, and 46% (28/61) from the proximal ureter. The first group of urologists completed significantly more procedures successfully, especially for the stones in the distal (95% vs 74%; P = 0.001) and middle ureter (66% vs 38%; P = 0.002), and their patients spent less time in the hospital postoperatively.
  
  
  CONCLUSIONS
  Urologists who started learning and performing endoscopic procedures at the beginning of their specialization are more successful in performing ureteroscopy. It is important that young specialists receive timely and systematic education and cooperate with more experienced colleagues.
authors.affiliation: Department of Urology, Clinical Hospital Center Split, Soltanska 1, 21000 Split, Croatia. davor.librenjak@st.t-com.hr
authors.forename: Davor
authors.initials: D
authors.lastname: Librenjak
authors.forename: Marijan
authors.initials: M
authors.lastname: Šitum
authors.forename: Dijana
authors.initials: D
authors.lastname: Gugić
authors.forename: Kazimir
authors.initials: K
authors.lastname: Milostić
authors.forename: Mario
authors.initials: M
authors.lastname: Duvnjak
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008096:Lithotripsy / Q000379:methods / Q000592:standards; D008297:Male; D020380:Needs Assessment / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D013038:Specialization / Q000592:standards*; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000503:physiopathology / Q000628:therapy*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000009:adverse effects / Q000193:education* / Q000295:instrumentation / Q000592:standards; D014572:Urology / Q000193:education*