Uncertainty During Ureteroscopy: Evaluating Surgeon Consensus on In Vivo Stone Dust After Laser Lithotripsy

Area of Science:

• Urology
• Endourology
• Surgical Technology

Background:

• Ureteroscopy (URS) with laser lithotripsy is a common procedure for kidney stones.
• Assessing stone dust quality and predicting stone-free status intraoperatively can guide treatment.
• Current methods rely on surgeon's visual assessment, which may lack standardization.

Purpose of the Study:

• To evaluate surgeon consensus on stone dust quality during URS.
• To assess the accuracy of predicting stone-free status based on intraoperative endoscopic appearance.
• To compare faculty and trainee performance in these assessments.

Main Methods:

• 16 ureteroscopic laser lithotripsy videos were reviewed by 15 urologists (faculty and trainees).
• Reviewers rated stone dust quality and predicted stone-free status.
• Inter-rater reliability (ICC) and prediction accuracy were analyzed.

Main Results:

• Poor inter-rater agreement on dust quality (ICC=0.41).
• Mean stone-free prediction accuracy was 63%, with no significant difference between faculty and trainees.
• Predicting residual fragments had 55% sensitivity and 72% specificity, with some cases leading to significant clinical events.

Conclusions:

• Surgeon assessment of stone dust quality is inconsistent.
• Predictive accuracy for stone-free status based on endoscopic appearance is limited.
• Standardized definitions and objective intraoperative tools are needed to optimize laser stone surgery outcomes.