LAUSR

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 - 2019 by high volume (HV), low volume (LV), endourology-fellowship trained (FT) and non-FT (NFT) urologists. Surgical outcomes including stone-free rate (SFR), complication and reoperation rates, and post-op imaging follow up were analyzed between groups. RESULTS 1,057 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% - 14.4% higher SFR, representing 2.7 - 3.6-fold greater odds of stone free outcomes for primary and secondary stones. Additionally, HV and FT had a 4.9% - 7.8% lower rate of postoperative complications and a 3.3% - 4.3% lower rate of reoperations, representing 1.9 - 4.0-fold lower odds of complications. Lastly, their patients had a 1.6 - 2.1-fold higher odds of post-op imaging follow up with a greater proportion receiving post-op imaging within the recommended 3-month post-op 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 post-op imaging follow up compared to less experienced urologists. Though 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.