Learning Curves in Urolithiasis Surgery: A Systematic Review: Association of Surgeons in Training 2018 Conference

Aim: To systematically assess the literature and determine the number of cases required to achieve competence in various urolithiasis procedures.

Method: A search protocol in keeping with the PRISMA flowchart was conducted and registered with the PROSPERO database (ID number: CRD42018085022). The EMBASE, MEDLINE and PsycINFO databases were systematically searched for articles from inception to January 2018. A subsequent hand search of reference sections was conducted. Studies in the English language relating to learning curves and urolithiasis procedures were included.

Result: A total of 18 studies were identified, which included 2,226 patients. The studies pertained to learning curves in ureteroscopy (4) and percutaneous nephrolithotomy (14). The learning curve of ureteroscopy ranged from 50 to 100 procedures. The number of percutaneous nephrolithotomy procedures to become competent ranged from 20 to 120. To become an expert in percutaneous nephrolithotomy a urologist must have carried out between 60 and 180 procedures.

Conclusion: The number of procedures required to reach a plateau in the learning curve differs according to procedure and outcome measure being observed. The majority of learning curves in the literature focus on more challenging urolithiasis procedures and there is a paucity of information pertaining to basic techniques such as extracorporeal shockwave lithotripsy and ureteroscopy.