Impact of a One-Year Endourology Fellowship on Ureteroscopy and HO Laser Lithotripsy Outcomes: A Focus on Ultrasound Findings

The learning curve for flexible ureteroscopy and Ho
laser lithotripsy (URS) is relatively short, raising questions about the necessity of extended endourological training. This study aimed to evaluate the effects of a one-year clinical fellowship in endourology (CFE) on surgical outcomes in stone patients treated with URS. A total of 303 stone patients were treated at a tertiary care referral center from January 2018 to June 2022 by five experienced surgeons, with two having completed a CFE at a specialized center in Paris. The optimal surgical outcome (OSO) was defined as the presence of residual fragments measuring 4 mm or less at one month postoperatively, confirmed through abdominal ultrasound and X-ray or CT imaging. Analysis revealed that 66.3% of patients treated by surgeons with a CFE achieved OSO compared to 51.6% treated by those without the fellowship (p=0.01). Univariate and multivariate logistic regression analyses indicated that the CFE significantly predicted OSO achievement, with an odds ratio of 2.24 (95% CI=1.29-3.88; p<0.01). Additionally, stone size and location, along with the imaging technique used, were also significant predictors of surgical success. Notably, the positive impact of the CFE was more pronounced in patients with larger stone burdens. These findings suggest that a clinical fellowship can significantly enhance surgical performance, leading to improved patient outcomes in the management of urinary stones.