Ureterorenoscopy performed by residents under expert supervision: a training approach ensuring patient safety and effectiveness.

OBJECTIVES: to evaluate the outcomes and postoperative complications of ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) for urolithiasis performed by residents under supervision compared to those performed by specialists. MATERIALS AND METHODS: The institutional endourology database was reviewed. Patients, stone characteristics – including Guy’s stone (GSS) and S.T.O.N.E. scores to describe the complexity of renal stones – perioperative and postoperative data, complications, and stone-free rate (SFR) were retrieved. Procedures were stratified based on whether a specialist or a supervised resident performed them. Multivariate logistic regression was used to analyze the association between stone characteristics and/or operator, and SFR. RESULTS: Out of 280 patients analyzed, 164 (58.6%) were operated on by specialists vs. 116 (41.4%) by supervised residents. Specialists treated larger stones (p < 0.04), but GSS and S.T.O.N.E. scores showed no significant differences. Supervised residents performed more URS than specialists (23.3% vs. 13.4%, p = 0.038). Operative time was shorter for supervised residents (70 vs. 75.5 min, p = 0.02). Patients operated by specialists were more likely discharged with indwelling ureteral stent (82.3% vs. 69.8%, p = 0.02), for a longer time (p = 0.004). Complication rates were similar, but patients operated by specialists had more stone-related events within 90 days (29.9% vs. 16.4%, p = 0.01). SFR was 58.5% for specialists and 63.8% for supervised residents (p = 0.4). Stone volume and stones’ multifocality were predictors of a poorer SFR, while an operation performed by a supervised resident was not a predictor (p = 1). CONCLUSIONS: Under the controlled environment and careful case selection typical of a supervised residency training program, resident-performed ureterorenoscopy for urolithiasis is safe and yields satisfactory postoperative outcomes.