Urologic training does not impact ability to accurately size kidney stone fragments

Accurate estimation of stone fragment size during ureteroscopy facilitates safe extraction. We aimed to determine whether training experience improves the accuracy of estimating fragment size. Six mock stones (range 1.2-7.4 mm) were placed in a renal model for simulated flexible ureteroscopy. Urology residents and high-volume ureteroscopy surgeons estimated fragment size and extractability through a 12/14-French sheath. Responses were compared among 3 training levels (PGY 1-2, PGY 3-5, and surgeons) and analyzed by objective measures of surgical experience and technical skill. Categorical and continuous variables were analyzed using ANOVA and Pearson correlation, respectively. 16 residents and 6 surgeons were included. Participants underestimated fragment size by 30% overall. As fragment size increased, the discrepancy between estimates and true size also increased. There was no statistical difference in accuracy among training groups and no association with experience or skill. Participants nearly always (98%) correctly identified < 4 mm fragments as extractable; in contrast, participants identified > 4 mm fragments as not extractable only 59% of the time. There was similarly no difference in predicting extraction by training level, experience, or skill. Both novice and experienced surgeons substantially underestimate fragment size during ureteroscopy, which may increase the risk of unsafe extraction. Technologies that enable real-time measurement may improve accuracy, regardless of surgeon experience.