INTRODUCTION: Ionizing radiation is used throughout urologic surgery and is known to cause a greater cancer risk with increasing exposure. The ICRP states that "it is the control of radiation dose that is important, no matter the source." However, there are few reports on the amount of radiation used by Urology residents during ureteroscopy (URS). We present the largest database evaluating fluoroscopy (fluoro) use during URS at a resident training program. Our objective is to assess the amount of fluoro use at varying levels of experience and to identify factors that lead to increased fluoro use.

METHODS: Retrospective data from 242 URS performed at two resident training sites were collected. 105 surgeries were done by 2 attending physicians without and 137 with residents (Uro1-Uro3). Patient data were collected from the EMR. Statistical analyses included ANOVA, Spearman correlations, and multiple linear regression (MLR).

RESULTS: Comparisons between Yr1 and Yr2 revealed significantly (p<0.05) decreased fluoro time (20.0 s) and operative time (12.2 m) for the Yr2 resident. Total operative time was significantly (p<0.05) decreased (11.1 m) for attending physicians operating on their own compared to a Yr1 resident. Significant (p<0.05) correlations with fluoro time were demonstrated for operative time, stone size, ureteral dilation, ureteral access sheath use, presence of a preoperative stent, resident year, and resident month. Operative time, ureteral dilation and a preoperative stent placement were significant predictors of fluoro time on MLR (p<0.05).

CONCLUSION: Fluoro time during retrograde URS was significantly reduced as residents gained more experience in the operating room. An increase in fluoro time was also associated with ureteral dilation, access sheath use, increasing stone size, and lack of pre-stenting. With knowledge of these factors, emphasis can be placed on using and teaching techniques that limit radiation exposure.