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      Outcome from 5-year live surgical demonstrations in urinary stone treatment: are outcomes compromised?

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          To compare intra- and post-operative outcomes of endourological live surgical demonstrations (LSDs) and routine surgical practice (RSP) for urinary stones.


          Consecutive ureterorenoscopic (URS) and percutaneous (PNL) urinary stone procedures over a 5-year period were reviewed. Procedures were divided into LSDs and RSP. Differences between the groups were separately analysed for URS and PNL. Primary outcomes included intra- and post-operative complication rates and grades. Secondary outcomes were operation time, length of hospital stay, stone-free rate, and retreatment rate. Pearson’s Chi-square analysis, Mann–Whitney U test, and logistic and linear regression were used to compare outcomes between LSDs and RSP.


          During the study period, we performed 666 URSs and 182 PNLs, and 151 of these procedures were LSDs. Among URSs, the overall intra-operative complication rate was 3.2% for LSDs and 2.5% for RSP ( p = 0.72) and the overall post-operative complication rate was 13.7% for LSDs and 8.8% for RSP ( p = 0.13). Among PNLs, the overall intra-operative complication rate was 8.9% for LSDs and 5.6% for RSP ( p = 0.52) and the overall post-operative complication rate was 28.6% for LSDs and 34.9% for RSP ( p = 0.40). For both URSs and PNLs, no statistically significant differences in complication grade scores were observed between LSDs and RSP. Operation time was significantly longer for LSD-URS group, but there was no difference between the PNL groups. There were no significant differences in length of hospital stay and stone-free rate. The retreatment rate was higher in the LSD-URS group compared with RSP-URS group but similar between the PNL groups. Multiple logistic regression analyses, adjusting for confounders, revealed no association between LSD and more or less favourable outcomes as compared to RSP.


          Live surgical demonstrations do not seem to compromise patients’ safety and outcomes when performed by specialised endourologists.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s00345-017-2050-4) contains supplementary material, which is available to authorized users.

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          Most cited references 14

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          Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy.

          Although widely used, the validity and reliability of the Clavien classification of postoperative complications have not been tested in urologic procedures, such as percutaneous nephrolithotomy (PCNL). To validate the Clavien score and categorise complications of PCNL. Data for 528 patients with complications after PCNL were used to create a set of 70 unique complication-management combinations. Clinical case summaries for each complication-management combination were compiled in a survey distributed to 98 urologists, who rated each combination using the Clavien classification. Interrater agreement for Clavien scores was estimated using Fleiss' kappa (κ). The relationship between Clavien score and the duration of postoperative hospital stay was analysed using multivariate nonlinear regression models that adjusted for operating time, preoperative urine microbial culture, presence of staghorn stone, and use of postoperative nephrostomy tube. Overall interrater agreement in grading postoperative complications was moderate (κ=0.457; p<0.001). Agreement was highest for Clavien score 5 and decreased with lower Clavien scores. Higher agreement was found for Clavien scores 3 and 4 than in subcategories of these scores. Postoperative stay increased with higher Clavien scores and was unaffected by inherent differences between study centres. A standard list of post-PCNL complications and their corresponding Clavien scores was created. Although the Clavien classification demonstrates high validity, interrater reliability is low for minor complications. To improve the reliability and consistency of reporting adverse outcomes of PCNL, we have assigned Clavien scores to complications of PCNL. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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            Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study.

            Ureteroscopy has traditionally been the preferred approach for treatment of distal and midureteral stones, with shock wave lithotripsy used for proximal ureteral stones.
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              Outcomes of Flexible Ureterorenoscopy for Solitary Renal Stones in the CROES URS Global Study.

              We determined the efficacy and safety of flexible ureterorenoscopy for single intrarenal calculi and further stratified efficacy by stone burden.

                Author and article information

                +31-20-5664377 , j.d.legemate@amc.uva.nl
                World J Urol
                World J Urol
                World Journal of Urology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                18 May 2017
                18 May 2017
                : 35
                : 11
                : 1745-1756
                [1 ]ISNI 0000000404654431, GRID grid.5650.6, Department of Urology, , AMC University Hospital, ; Meibergdreef 9, 1105 AZ Amsterdam Z-O, The Netherlands
                [2 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Department of Urology, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, , University of Milan, ; Milan, Italy
                [3 ]ISNI 0000 0001 1955 3500, GRID grid.5805.8, Department of Urology, Tenon Hospital, , Pierre et Marie Curie University, ; Paris, France
                © The Author(s) 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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                © Springer-Verlag GmbH Germany 2017


                stones, live, surgical, demonstrations, ureteroscopy, percutaneous, lithotomy, urolithiasis


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