Variations Among Urology Trainees in Their Use of Fluoroscopy During Ureteroscopy

Background and Purpose: Recently, surgeon behavior has been identified as a determinant of fluoroscopy time (FT) during ureteroscopy (URS). In a training program, postgraduate trainees (PGTs) assist in performing URS under direct supervision of an attending urologist. Therefore, the aim of the present study was to assess variations among PGTs in their use of FT during URS. Patients and Methods: A retrospective review of prospectively collected data was performed for consecutive patients undergoing URS between July 2009 and December 2010 using standard fluoroscopy (30 frames per second). Urology PGTs in the fourth year assisted in performing these cases under the direct supervision of a single endourologist. Patient and stone characteristics together with operative data were compared among PGTs using univariate and multivariate analyses. Results: Seven PGTs (A, B, C, D, E, F, and G) assisted in 100 URS with a median (range) of 13 (11-18) procedures per trainee. Mean FT (95% confidence interval) for trainees A through G were 194 (115-272), 104 (65-144), 91 (66-117), 117 (58-175), 91 (52-131), 107 (7-143), and 64 (36-91) seconds, respectively (P = 0.004). There were no significant differences among trainees in terms of patient (age and sex), stone (size, laterality, location, and multiplicity), and operative characteristics (operative time and balloon dilation) (P > 0.05). Trainees, however, varied significantly in their use of access sheath (P = 0.03). Trainees, male sex, balloon dilation, ureteral access sheath, and residual stones maintained their significance as predictors of FT on multivariate analysis. Conclusion: PGTs, in addition to male sex, balloon dilation, ureteral access sheath, and residual stones were significant predictors of FT during URS. Whether these differences in the behavior of PGTs are intrinsic to themselves or from perioperative factors remains to be clarified.