Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large or complex renal stones. Renal drainage after the procedure is most commonly via nephrostomy tube or indwelling ureteral stent, but the optimal duration of ureteral stents after PCNL is currently unknown. This study describes the post-operative events occurring with early stent removal on post-operative day one (POD1) in patients undergoing uncomplicated PCNL. Methods: We identified 336 patients from a single institution that underwent PCNL between 1/1/2020 and 6/1/2021. Of these, 106 patients with uncomplicated procedures that met inclusion criteria for early stent removal on POD1 were included. Retrospective chart review was performed to collect demographic information, operative data, and to identify adverse outcomes including additional procedures, patient telephone calls for symptoms, complications and emergency department (ED) visits. Results: Mean (SD) patient age was 54 (15.1) years and 56% of patients were morbidly obese (Body Mass Index [BMI] >30). Overall post-operative complication rate was low (18.8%) and limited primarily to Clavien I/II complications with only two Clavien III (1.9%) complications. Telephone calls or electronic messages were received from 37.7% of patients, with 16% requiring a visit to the ED or clinic. The most common reason for an ED visit was flank pain (11.1%). Conclusions: Early stent removal on POD1 may lead to pain-related telephone calls but appears to be a generally safe and effective management option in carefully selected patients undergoing uncomplicated PCNL.
RESULTS: Data on 87 subjects enrolled in the fellowship between were collated. While all subjects successfully completed the 1-wk robotic skills course, only 26 (30%) fellows achieved the certificate of excellence. The completion rate by year was 20% in 2018, 29% in 2019, 36.4% in 2020, and 31.4% in 2021. Therefore, the COVID-19 pandemic had only a modest impact on completion rate. The response rate to the telephone interview survey was 77%. The following reasons for non-completion emerged: insufficient console exposure (49%), insufficient fellowship duration (20%), COVID-19 pandemic (11%), logistic difficulties in submitting the video (20%).CONCLUSIONS: The CC-ERUS for RARP was the first validated robotic curriculum in the world, and still one of the very few outcome-based fellowships. Nonetheless, we observed a low completion rate that needs to be addressed with appropriate actions. To increase the fellowship completion rate, three solutions should be considered by the ERUS board: 1. Review of the Host Centers, to exclude those which do not meet the certification criteria (e.g. insufficient console time for fellows) 2. Periodical Train-The-Trainers courses for the mentors at host centers 3. Follow-up procedural diary: the fellows will be requested to submit videos of each phase while progressing in their modular training and self-assess their performance using validated RARP metrics.
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