Presentation Authors: Manuel Armas-Phan*, David Tzou, David Bayne, Scott Wiener, Adam Gadzinski, Ian Metzler, Kelly Walker, Marshall Stoller, Tom Chi, San Francisco, CA
Introduction: Ultrasound (US) use during percutaneous nephrolithomy (PCNL) is becoming increasingly adopted by American urologists. Evaluation of attending physician&[prime]s learning curve in adopting an US-guided renal puncture & dilation previously has been undertaken. Wide-spread adoption is expected as exposure to ultrasound directed renal puncture during urologic training increases, but how to effectively obtain mastery during training will require investigation. The aim of our study was to evaluate the urologic trainee&[prime]s learning curve in successfully obtaining renal access under US-guidance.
Methods: Patients undergoing US-guided PCNL at a single academic urology training program between 5/2016 & 3/2018 were evaluated including cases where a resident attempted tract access. The primary endpoint measured was success of the trainee in obtaining ultrasound-guided renal access. A failed attempt was defined by the attending physician successfully obtaining renal access instead, or any use of fluoroscopy.
Results: 65 US-guided renal punctures were performed. Renal punctures were attempted by junior residents (PGY-2 & 3), senior residents (PGY-4), & chief residents (PGY-6) on 18, 32, & 15 cases, respectively. There were no differences in patient characteristics. PGY-4 performed the most puncture attempts. There were no differences in successful attempts between junior, senior, & chief residents. Consecutive US-guided renal access attempts were followed for 3 residents (AG n=9; IM n=8; KW n=7). The proportions of successful attempts for the 1st, 2nd, & 3rd tertile of cases were 100%, 100%, & 33%, for AG (P > 0.10), 100%, 33%, & 50% for IM (P > 0.10), & 66%, 66%, 0%, for KW (P > 0.10).
Conclusions: US-guided renal access can be performed successfully by residents at any level of urology training. At our institution, most US-guided puncture attempts are performed as a PGY-4 though the puncture success rate was constant across all years. More US renal punctures as a junior resident may improve success rates as a PGY-4 & PGY-6. Learning can be further enhanced through surgical skill simulations. Future investigations will address these questions.
Source of Funding: NIH P20-DK-116193, NIH R21-DK-109433, NIH TL1-TR-001871, Urology Care Foundation Student Fellowship