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. 2025 Oct 1;25(1):245.
doi: 10.1186/s12894-025-01909-1.

Ureterorenoscopy performed by residents under expert supervision: a training approach ensuring patient safety and effectiveness

Emanuele Serafin  1 , Andrea Franceschini  1 , Francesco Ditonno  1 , Endri Toska  1 , Alberto Baielli  1 , Antonio Raiti  1 , Damiano D'Aietti  1 , Francesca Montanaro  1 , Luca Rahmati  1 , Mattia Ronca  1 , Peres Fokana Pongmoni  1 , Sonia Costantino  1 , Vincenzo Vetro  1 , Alessandro Veccia  1 , Riccardo Rizzetto  1 , Alberto Bianchi  1 , Alessandra Gozzo  1 , Vincenzo Lacola  1 , Maria Angela Cerruto  1 , Riccardo Bertolo  2 , Alessandro Antonelli  1
Affiliations

Ureterorenoscopy performed by residents under expert supervision: a training approach ensuring patient safety and effectiveness

Emanuele Serafin et al. BMC Urol. .

Abstract

Objectives: to evaluate the outcomes and postoperative complications of ureteroscopy (URS) and retrograde intrarenal surgery (RIRS) for urolithiasis performed by residents under supervision compared to those performed by specialists.

Materials and methods: The institutional endourology database was reviewed. Patients, stone characteristics – including Guy’s stone (GSS) and S.T.O.N.E. scores to describe the complexity of renal stones – perioperative and postoperative data, complications, and stone-free rate (SFR) were retrieved. Procedures were stratified based on whether a specialist or a supervised resident performed them. Multivariate logistic regression was used to analyze the association between stone characteristics and/or operator, and SFR.

Results: Out of 280 patients analyzed, 164 (58.6%) were operated on by specialists vs. 116 (41.4%) by supervised residents. Specialists treated larger stones (p < 0.04), but GSS and S.T.O.N.E. scores showed no significant differences. Supervised residents performed more URS than specialists (23.3% vs. 13.4%, p = 0.038). Operative time was shorter for supervised residents (70 vs. 75.5 min, p = 0.02). Patients operated by specialists were more likely discharged with indwelling ureteral stent (82.3% vs. 69.8%, p = 0.02), for a longer time (p = 0.004). Complication rates were similar, but patients operated by specialists had more stone-related events within 90 days (29.9% vs. 16.4%, p = 0.01). SFR was 58.5% for specialists and 63.8% for supervised residents (p = 0.4). Stone volume and stones’ multifocality were predictors of a poorer SFR, while an operation performed by a supervised resident was not a predictor (p = 1).

Conclusions: Under the controlled environment and careful case selection typical of a supervised residency training program, resident-performed ureterorenoscopy for urolithiasis is safe and yields satisfactory postoperative outcomes.

Supplementary information: The online version contains supplementary material available at 10.1186/s12894-025-01909-1.

Keywords: Retrograde intra-renal surgery; Stone; Training; Ureteroscopy; Urolithiasis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Institutional and/or licensing committee approval was not obtained due to the retrospective nature of the present analysis (ethical approval waiver by Comitato etico Territoriale Area Sud-Ovest Veneto - CET-ASOV, Azienda Ospedaliera Universitaria Integrata Verona c/o UOC Farmacia, P.le Stefani, 1 37126 Verona). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardian(s).Institutional and/or licensing committee approval was not obtained due to the retrospective nature of the present analysis (ethical approval waiver by Comitato etico Territoriale Area Sud-Ovest Veneto - CET-ASOV, Azienda Ospedaliera Universitaria Integrata Verona c/o UOC Farmacia, P.le Stefani, 1 37126 Verona). The study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardian(s). Consent for publication: All authors have reviewed and approved the final manuscript and consent to its publication. Competing interests: The authors declare no competing interests.

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