Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Germany.
Urologische Klinik, Carl-Thiem-Klinikum Cottbus gGmbH, Cottbus, Germany.
Urolithiasis. 2019 Oct;47(5):473-479. doi: 10.1007/s00240-018-1073-7. Epub 2018 Jul 4.
Within the BUSTER trial, we analyzed the surgeon's amount of experience and other parameters associated with URS procedures regarding the stone-free rate, complication rate, and operative time. Patient characteristics and surgical details on 307 URS procedures were prospectively documented according to a standardized study protocol at 14 German centers 01-04/2015. Surgeon's experience was correlated to clinical characteristics, and its impact on the stone-free rate, complication rate, and operative time subjected to multivariate analysis. 76 (25%), 66 (21%) and 165 (54%) of 307 URS procedures were carried out by residents, young specialists, and experienced specialists (> 5 years after board certification), respectively. Median stone size was 6 mm, median operative time 35 min. A ureteral stent was placed at the end of 82% of procedures. Stone-free rate and stone-free rate including minimal residual stone fragments (adequate for spontaneous clearance) following URS were 69 and 91%, respectively. No complications were documented during the hospital stays of 89% of patients (Clavien-Dindo grade 0). According to multivariate analysis, experienced specialists achieved a 2.2-fold higher stone-free rate compared to residents (p = 0.038), but used post-URS stenting 2.6-fold more frequently (p = 0.023). Surgeon's experience had no significant impact on the complication rate. We observed no differences in this study's main endpoints, namely the stone-free and complication rates, between residents and young specialists, but experienced specialists' stone-free rate was significantly higher. During this cross-sectional study, 75% of URS procedures were performed by specialists. The experienced specialists' more than two-fold higher stone-free rate compared to residents' justifies ongoing efforts to establish structured URS training programs.
在 BUSTER 试验中，我们分析了与 URS 手术相关的术者经验和其他参数与无石率、并发症率和手术时间之间的关系。根据标准化研究方案，2015 年 1 月至 4 月在德国的 14 个中心前瞻性地记录了 307 例 URS 手术的患者特征和手术细节。术者经验与临床特征相关，其对无石率、并发症率和手术时间的影响通过多变量分析进行了分析。307 例 URS 手术中，住院医师、年轻专家和经验丰富的专家（委员会认证后 > 5 年）分别进行了 76 例（25%）、66 例（21%）和 165 例（54%）。中位结石大小为 6mm，中位手术时间为 35 分钟。82%的手术结束时放置了输尿管支架。URS 后无石率和包括最小残余结石碎片（适合自发清除）的无石率分别为 69%和 91%。89%的患者住院期间无并发症（Clavien-Dindo 分级 0）。根据多变量分析，与住院医师相比，经验丰富的专家的无石率高 2.2 倍（p=0.038），但术后使用输尿管支架的频率高 2.6 倍（p=0.023）。术者经验对并发症率无显著影响。在本研究的主要终点（即无石率和并发症率）方面，我们没有观察到住院医师和年轻专家之间的差异，但经验丰富的专家的无石率明显更高。在这项横断面研究中，75%的 URS 手术由专家完成。与住院医师相比，经验丰富的专家的无石率高 2 倍以上，这证明了建立结构化 URS 培训计划的努力是合理的。
