title: Can endourology fellowship training enhance minimally invasive surgery in urology practice?
abstract: OBJECTIVE
  To evaluate the influence of fellowship training in endourology on different endourological procedures in a single institution.
  
  
  METHODS
  The operative records of endourological and open surgeries were reviewed. Data analysed included numbers, types, and technical issues related to surgeries. The early study period ranged from September 1998 to September 2004, and the later period from January 2014 to June 2016. The study duration was classified into three periods according to the availability of an endourology fellowship trained member of staff (EFTS). In period A (September 1998 to September 2001) no EFTS was available, in period B (October 2001 to September 2004) an EFTS joined the urology unit, and in period C (January 2014 to June-2016) the EFTS had left the urology unit.
  
  
  RESULTS
  In periods B and C the number of rigid ureteroscopy (URS) significantly increased compared with period A. Also, flexible URS was used for the first time in period B and continued in period C. The number of percutaneous nephrolithotomies increased in period B and continued to be performed in period C. Laparoscopic urological surgery was not undertaken in period A, and only done in four cases in period C, whilst it was performed in 62 patients in period B. Holmium laser enucleation of the prostate was carried out in 36 patients during period B and not performed in periods A and C. Finally, the number of open stone surgeries decreased in periods B and C.
  
  
  CONCLUSIONS
  The introduction of an EFTS definitely enhanced the practice of minimally invasive procedures.
authors.affiliation: Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait; Department of Surgery, Kuwait University, Safat, Kuwait.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Al-Kandari
authors.affiliation: Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait.
authors.forename: Yehya
authors.initials: Y
authors.lastname: Elshebiny
authors.affiliation: Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait.
authors.forename: Hamdy
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Adan Urology Unit, Ministry of Health, Kuwait City, Kuwait.
authors.forename: Ahmad
authors.initials: A
authors.lastname: AlShammari
authors.affiliation: Urology and Nephrology Center, Mansoura, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Shokeir
keywords: EFTS, endourology fellowship trained member of staff; Endourology; Fellowship; HOL(EP), holmium laser (enucleation of the prostate); Minimally invasive; PCNL, percutaneous nephrolithotomy; Practice; URS, ureteroscopy