With the ever-increasing focus on patient safety, centralisation of services for major procedures is becoming more common. Using data from the Clinical Research Office of the Endourological Society (CROES) Ureteroscopy Global Study database, a prospective observational multicentre study created to examine factors affecting ureteroscopy (URS) outcome, this team evaluated the impact of case volume on the outcome of the more commonly performed ureteroscopy for stone treatment. Across the 114 participating centres, 8189 patients with ureteric stones were treated with ureteroscopy over the study period. The mean case volume at participating centres was 67 – the 58 centres with case volume lower or equal to this were deemed low-volume centres, with the remaining 56 centres designated high-volume centres. One thousand three hundred and twenty-nine patients were treated at low-volume centres, with 6860 treated at high-volume centres. The study found patients treated at high-volume centres had a lower ASA score but a higher mean stone burden. Operating time at the high-volume centres was significantly shorter, with lower rates of complications such as bleeding and perforation, higher stone-free rates, shorter lengths of stay and lower rate of readmission within three months. Although there were some limitations to the study, such as the heterogenicity of participating centres, the results highlight how improved patient outcome can be associated with high-volume centres. This may not only influence patient treatment in the future, but also have implications on the optimum placements for trainee urologists.

Impact of case volume on outcomes of ureteroscopy for ureteral stones: the Clinical Research Office of the Endourological Society Ureteroscopy Global Study.
Kandasami SV, Mamoulakis C, El-Nahas AR, et al.
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Sophia Cashman

Cambridge University Hospitals NHS Foundation Trust.

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