title: Fluoroscopy time during uncomplicated unilateral ureteroscopy for urolithiasis decreases with urology resident experience.
abstract: OBJECTIVE
  To determine predictors of fluoroscopy time during uncomplicated, unilateral ureteroscopy for urolithiasis performed by urology residents during the first 2 years of residency.
  
  
  METHODS
  The patient charts and computed tomography scans of consecutive, unilateral, uncomplicated ureteroscopy cases for urolithiasis were retrospectively reviewed. The cases were performed by beginning urology residents over the course of their first 2 years of urology residency training.
  
  
  RESULTS
  A total of 200 ureteroscopy cases were reviewed. The mean stone diameter was 7.1 (±3.2) mm. Forty-three percent of cases were performed for renal stones and 58 % for ureteral stones. The mean operative time was 80.2 (±36.9) min. The mean fluoroscopy time was 69.1 (±38.2) s. No significant differences existed between cases performed by each of the two residents, and no statistical differences in case difficulty were observed throughout the study period. Linear regression analysis revealed the strongest association with lower fluoroscopy time to be increasing resident experience (p < 0.001). By the end of the 2-year review, fluoroscopy time decreased by 79 % from 135 to 29 s per case. Other significant factors associated with increasing fluoroscopy time were placement of a postoperative stent under fluoroscopic guidance (p < 0.001), utilization of a flexible ureteroscope as opposed to a semirigid ureteroscope (p < 0.001), and balloon dilation of the ureteral orifice (p < 0.001).
  
  
  CONCLUSIONS
  Fluoroscopy time during uncomplicated, unilateral ureteroscopy for urolithiasis decreases with increasing urology resident operative experience. Other technical options during ureteroscopy were also found to influence fluoroscopy time.
authors.affiliation: Department of Urology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Lancaster R
authors.initials: LR
authors.lastname: Weld
authors.forename: Uzoamaka O
authors.initials: UO
authors.lastname: Nwoye
authors.forename: Richard B
authors.initials: RB
authors.lastname: Knight
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Baumgartner
authors.forename: James S
authors.initials: JS
authors.lastname: Ebertowski
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Stringer
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kasprenski
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Weld
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007396:Internship and Residency; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D000069079:Radiation Exposure; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D018666:Ureteroscopy; D052878:Urolithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D014572:Urology / Q000193:education*