Urology Journal

Abstract

Purpose: To determine the number of percutaneous nephrolithotomy (PCNL) operations which are required to achieve competence or excellence. Materials and Methods: One hundred and five consecutive PCNL operations performed by a fellow in endourology, with no previous experience in performing solo PCNL, were studied. Operation duration, stone extraction percent, stone-free rate, number of access, tubeless cases, and complications were studied in sequential groups of 15 patients as the surgeon gained experience. Results: Operation duration decreased from the mean of 95.4 minutes in the first to 15^th patients to 78.3 minutes in the 31^st to 45^th patients, and then remained unchanged. Minor complications were only observed in the first to 45^th patients. Stone extraction percent increased from the mean of 88.3% in the first to 15^th patients to 99.3% in 91^st to 105^th patients. Percentage of patients with no residual fragments decreased from 53% in the first to 15^th patients to 6.7% in the 91^st to 105^th patients. No statistically significant differences were observed in estimated blood loss or transfusion rate between sequential groups of subjects. Conclusion: An improvement in operation duration was observed, and absence of complications was achieved after 45 cases. The improvement in stone clearance was observed up to the last subjects. Competence and excellence were achieved after 45 and 105 operations, respectively.