Abstract：
Introduction: Surgical experience is associated with superior outcomes in complex urologic cases, such as prostatectomy, nephrectomy, and cystectomy. The question remains whether experience is predictive of outcomes for less complex procedures, such as ureteroscopy (URS). Our study examined how case volume and endourology-fellowship training impacts URS outcomes. Methods: We retrospectively reviewed URS cases from 2017 to 2019 by high ureteroscopy volume urologists (HV), low ureteroscopy volume urologists (LV), endourology-fellowship trained (FT), and non-endourology FT (NFT) urologists. Surgical outcomes including stone-free rate (SFR), complication and reoperation rates, and postoperative imaging follow-up were analyzed between groups. Results: One thousand fifty-seven cases were reviewed across 23 urologists: 6 HV, 17 LV, 3 FT, and 20 NFT. Both FT and HV operated on more complex cases with lower rates of pre-stented patients. HV also operated on patients with higher rates of renal stones, lower pole involvement, and prior failed procedures. Despite this, FT and HV showed between 11.7% and 14.4% higher SFR, representing 2.7- to 3.6-fold greater odds of stone-free outcomes for primary and secondary stones. Additionally, HV and FT had a 4.9% to 7.8% lower rate of postoperative complications and a 3.3% to 4.3% lower rate of reoperations, representing 1.9- to 4.0-fold lower odds of complications. Finally, their patients had a 1.6- to 2.1-fold higher odds of postoperative imaging follow-up with a greater proportion receiving postoperative imaging within the recommended 3-month postoperative period. Conclusions: More experienced urologists, as defined by higher case volume and endourology-fellowship training, had higher SFR, lower complication and reoperation rates, and better postoperative imaging follow-up compared with less experienced urologists. Although less experienced urologists had outcomes in-line with clinical and literature standards, continued training and experience may be a predictor of better outcomes across multiple URS modalities.
摘要：
背景：在复杂的泌尿外科病例（如前列腺切除术）中，手术经验与优越的结果相关，肾切除术,膀胱切除术.问题仍然是经验是否可以预测输尿管镜检查（URS）等较不复杂的手术的结果。我们的研究检查了病例量和内分泌研究金培训如何影响URS结果。
方法：我们回顾性分析了2017-2019年的URS病例，低音量（LV），经腔泌尿外科研究金培训（FT）和非FT（NFT）泌尿科医师。手术结果包括无结石率（SFR），并发症和再手术率，并对术后影像学随访进行组间分析。
结果：23位泌尿科医师对1,057例病例进行了回顾：6HV，17低压,3FT和20NFT。FT和HV均适用于较复杂的病例，而支架植入前的患者发生率较低。HV还对肾结石发生率较高的患者进行手术，较低的极参与，和先前失败的程序。尽管如此,FT和HV显示SFR高出11.7%-14.4%，代表主要和次要结石的无结石结果的几率增加2.7-3.6倍。此外,HV和FT术后并发症发生率低4.9%-7.8%，再次手术发生率低3.3%-4.3%，代表并发症的几率降低1.9-4.0倍。最后,他们的患者接受术后影像学随访的几率高1.6-2.1倍,在推荐的术后3个月内接受术后影像学随访的比例更高.
结论：更有经验的泌尿科医师，根据较高的病例量和内分泌学研究金培训的定义，SFR较高，并发症和再手术率较低，与经验较少的泌尿科医师相比，术后影像学随访更好。尽管经验较少的泌尿科医师的结果符合临床和文献标准，持续的培训和经验可能是多种URS模式更好结果的预测指标。
方法：我们回顾性分析了2017-2019年的URS病例，低音量（LV），经腔泌尿外科研究金培训（FT）和非FT（NFT）泌尿科医师。手术结果包括无结石率（SFR），并发症和再手术率，并对术后影像学随访进行组间分析。
结果：23位泌尿科医师对1,057例病例进行了回顾：6HV，17低压,3FT和20NFT。FT和HV均适用于较复杂的病例，而支架植入前的患者发生率较低。HV还对肾结石发生率较高的患者进行手术，较低的极参与，和先前失败的程序。尽管如此,FT和HV显示SFR高出11.7%-14.4%，代表主要和次要结石的无结石结果的几率增加2.7-3.6倍。此外,HV和FT术后并发症发生率低4.9%-7.8%，再次手术发生率低3.3%-4.3%，代表并发症的几率降低1.9-4.0倍。最后,他们的患者接受术后影像学随访的几率高1.6-2.1倍,在推荐的术后3个月内接受术后影像学随访的比例更高.
结论：更有经验的泌尿科医师，根据较高的病例量和内分泌学研究金培训的定义，SFR较高，并发症和再手术率较低，与经验较少的泌尿科医师相比，术后影像学随访更好。尽管经验较少的泌尿科医师的结果符合临床和文献标准，持续的培训和经验可能是多种URS模式更好结果的预测指标。
