Surgical experience obtained by urology registrars : changes in the volume and spectrum of operative procedures: 1975 - 2002

ABSTRACT

Objective: To analyze changes in the operative experience of Urology registrars at Tygerberg Hospital; an academic training hospital attached to the University of Stellenbosch; South Africa. Materials and Methods: Computerized analysis of 32;703 operating room cases (60;096 procedures) performed or assisted by 30 registrars in the period January 1975 to December 2002. Results: The average total number of procedures/registrar decreased by 32(from 1752 to 1163) for those who started training in the period 1990-99 compared with 1975-90 (p=0.0005); largely due to a 35reduction in bed numbers and theatre time resulting from budgetary restrictions. Comparison of the period 1994-2002 with 1976-84 showed a 4-fold increase in percutaneous nephrolithotomy; radical prostatectomy and inguinal herniotomy; with a moderate (50) increase in bladder rupture repair (54); circumcision (89); orchidopexy (105); insertion of peritoneal dialysis catheter (274); laparotomy (54) and surgical debridement (215). There was a 50decrease in nephrectomy (57); renal exploration for trauma (75); open kidney stone surgery (87); pyeloplasty (44); reimplantation of the ureter (60); ureterolithotomy (66); suprapubic cysto-tomy (71); transurethral resection of the prostate (54); open prostatectomy (90); urethral dilatation (78); internal urethrotomy (54); urethroplasty (72); varicocelectomy (62); and creation of arteriovenous fistula for dialysis (58). Conclusions: There have been substantial changes in the spectrum of surgical procedures performed or assisted by Urology registrars in the period 1975 to 2002. The significant decrease in the total number of procedures per registrar in the past decade is a reason for concern; although it remains unknown what the minimum number of any given urological procedure should be in order to ensure adequate operative training