Training in ureteroscopy: a critical appraisal of the literature


Jean de la Rosette, Department of Urology, AMC University Hospital, Amsterdam, The Netherlands. e-mail:


What’s known on the subject? and What does the study add?

Ureteroscopy outcome depends on the availability of the technological equipment and the surgeon experience.

This study tries to define the learning curve of ureteroscopy, to underline the current quality of training and to propose the minimum requirements for a curriculum in ureteroscopy.

The aim of the present review was to study factors influencing training and the maintenance of skills in performing ureteroscopy (URS). We searched on the following keywords in the Medline, Embase and Cochrane databases: renal or ureteric stone; ureteroscopy; endourology; educational; training; learning curve; expertise; skill; residency; practice; simulator; and robotics. We have defined, when possible, levels and grades of evidence, based on 2009 recommendations of the Oxford Centre for Evidence-Based Medicine. We found that technological advancement and surgeon experience is a predictive factor for success or complications of URS. Experience may be related to special endourology training, time passed after basic training and the number of procedures performed. Studies suggest that a resident must perform a certain amount of cases to gain proficiency with URS, but there is still a need for well designed studies for the learning curve of URS to be accurately defined. Training models may be useful for training in URS and stone disintegration. Stone centres that provide all the endoscopic treatment options seem to provide the best conditions to ensure a sufficient volume of patients required. Defining minimum requirements for training in URS and for maintaining certification is a major challenge, as is defining the learning curve in URS. Careful curriculum design in high-volume stone centres may be the key to optimizing URS training.