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Background: The Clinical Research Office of the Endourological Society (CROES) undertook the Ureteroscopy Global Study to establish a prospective global database to examine the worldwide use of ureteroscopy (URS) and to determine factors affecting outcome., Objective: To investigate the influence of case volume on the outcomes of URS for ureteral stones., Design, Setting, and Participants: The URS Global Study collected prospective data on consecutive patients with urinary stones treated with URS at 114 centres worldwide for 1 yr. Centres were identified as low or high volume based on the median overall annual case volume., Outcome Measurements and Statistical Analysis: Pre- and intraoperative characteristics, and postoperative outcomes in patients at low- and high-volume centres were compared. The relationships between case volume and stone-free rate (SFR), stone burden, complications, and hospital stay were explored using multivariate regression analysis., Results and Limitations: Across all centres, the median case volume was 67; 58 and 56 centres were designated as low volume and high volume, respectively. URS procedures at high-volume centres took significantly less time to conduct. Mean SFR was 91.9% and 86.3% at high- and low-volume centres, respectively (p<0.001); the adjusted probability of a stone-free outcome increased with increasing case volume (p<0.001). Patients treated at a high-volume centre were less likely to need retreatment, had shorter postoperative hospital stay, were less likely to be readmitted within 3 mo, and had fewer and less severe complications. At case volumes approximately >200, the probability of complications decreased with increasing case volume (p=0.02). The study is limited by the heterogeneity of participating centres and surgeons and the inclusion of patients treated by more than one approach., Conclusions: In the treatment of ureteral stones with URS, high-volume centres achieve better outcomes than low-volume centres. Several outcome measures for URS improve with an increase in case volume., Patient Summary: Outcomes following treatment of ureteral stones by ureteroscopy (URS) were studied in a large group of patients at centres worldwide. The proportion of successful procedures (ie, those in which patients became stone free) increased as the annual volume of URS at a hospital increased. Hospital stays were shorter and postoperative complications were less likely at high-volume hospitals. We conclude that for URS, the best outcomes are seen in patients treated at high-volume hospitals., (Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Context: Due to the complexity and challenging nature of radical prostatectomy (RP), it is likely that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as by the hospital., Objective: To review systematically the association between hospital and surgeon volume and perioperative, oncologic, and functional outcomes after RP., Evidence Acquisition: A systematic review of the literature was performed, searching PubMed, Embase, and Scopus databases for original and review articles between January 1, 1995, and December 31, 2011. Inclusion and exclusion criteria comprised RP, hospital and/or surgeon volume reported as a predictor variable, a measurable end point, and a description of multiple hospitals or surgeons., Evidence Synthesis: Overall 45 publications fulfilled the inclusion criteria, where most data originated from retrospective institutional or population-based cohorts. Studies generally focused on hospital or surgeon volume separately. Although most of these analyses corroborated the impact of increasing volume with better outcomes, some failed to find any significant effect. Studies also differed with respect to the proposed volume cut-off for improved outcomes, as well as the statistical means of evaluating the volume-outcome relationship. Five studies simultaneously compared hospital and surgeon volume, where results suggest that the importance of either hospital or surgeon volume largely depends on the end point of interest., Conclusions: Undeniable evidence suggests that increasing volume improves outcomes. Although it would seem reasonable to refer RP patients to high-volume centers, such regionalization may not be entirely practical. As such, the implications of such a shift in practice have yet to be fully determined and warrant further exploration., (Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.)