Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Education and training evolution in urolithiasis:A perspective from European School of Urology

Objective:With the worldwide increase in urolithiasis prevalence,the present study aimed to delineate and summarise recent evolutions in training for the management of urolithiasis.Methods:A PubMed search using the key words“simulation”,“training”,“ureteroscopy”,“RIRS”,“URS”,“percutaneous nephrolithotomy”,“PCNL”,“virtual reality”,“augmented reality”,“artificial intelligence”,“healthcare”,“curriculum”,and“assessment”was used to examine how education and training in urolithiasis have adapted over recent years.Focus was placed on the role of high-and low-fidelity simulation models,virtual reality and artificial intelligence,and standardised assessment and curriculum.Results:This review supports the necessity to incorporate technology,simulation,and other skill enhancement training modalities into surgical training.However,these cannot solely replace mentored training with an experienced professional supervisor.Whilst technological and simulation advancements are likely to prove increasingly important in urolithiasis training,it is just as important for stratification of robust curricula with validated assessment.We also propose a pathway for future training.Conclusion:Endourology subspeciality training programmes have successfully incorporated simulation model-based training for skill acquisition,refinement,and improving operative outcomes.Success is achieved by maintaining a delicate balance between machine and in person mentor-based training.A trainee-centred model that follows the proposed curriculum could aid this balance for the future generation of trainees.

Role of simulation in kidney stone disease:A systematic review of literature trends in the 26 years

BACKGROUND Minimally invasive techniques for treatment of urinary stones requires expertise,experience and endoscopic skills.Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities.AIM To report the publication trend of‘simulation in urolithiasis’over the last 26 years.METHODS Research of all published papers on“Simulation in Urolithiasis”was performed through PubMed database over the last 26 years,from January 1997 to December 2022.Papers were labelled and divided in three subgroups:(1)Training papers;(2)Clinical simulation application or surgical procedures;and(3)Diagnostic radiology simulation.Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades:period-1(1997-2009)and period-2(2010-2022).RESULTS A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years(training:n=94,surgical procedures:n=66,and radiology:n=8).The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2,an increase of+269%(P=0.0002).Each subgroup shows a growing trend of publications from Period-1 to Period-2:training papers+279%(P=0.001),surgical simulations+264%(P=0.0180)and radiological simulations+200%(P=0.2105).CONCLUSION In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices,with simulators now a part of training programs.With the development of 3D-printed and high-fidelity models,simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.

Evolution of endoscopic extraperitoneal radical prostatectomy （EERPE）： technique and outcome

Endoscopic extraperitoneal radical prostatectomy （EERPE） is a well-established and standardized technique for treating patients with localized prostate cancer. Nevertheless, the procedure is continuously being refined with the expansion of anatomical knowledge. The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure＇s established benefits in terms of potency, continence and oncological management. In this study, the technique and its evolution are presented in detail, along with an analysis of its clinical efficacy. We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy, and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.

Influence of bladder neck suspension stitches on early continence after radical prostatectomy： a prospective randomized study of 180 patients

Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck （vesicourethral anastomosis） suspension on the outcome of extraperitoneal endoscopic radical prostatectomy （EERPE）. In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE （nsEERPE） （n=45）, and Group 2 included patients who underwent nsEERPE with bladder neck suspension （BNS, n=45）. Groups 3 （n=45） and 4 （n=45） included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads （pad weighing test） on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were conti nent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group I and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.

Grafts in Peyronie’s surgery without the use of prostheses:a systematic review and meta-analysis

Peyronie’s disease(PD)is characterized by abnormal penile curvature,and various surgical methods have been developed usingdifferent graft materials.However,there is currently no universal agreement on which type of graft is the best.The objective of thisreview was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD.A literature search was conducted using electronic databases,including PubMed,Scopus,and the Cochrane Library.The patients,intervention,comparison,and outcome(PICO)approach was used to define the eligibility of studies.Two authors independentlyselected studies,evaluated them,and extracted data.Random-effect models using the DerSimonian–Laird method were used.Moststudies were single-arm studies and had a high risk of bias.Buccal mucosa grafts(BMG)were found to result in the highest penilestraightening rates and were associated with the least de novo erectile dysfunction.TachoSil grafts demonstrated a high successrate in straightening despite a higher mean preoperative curvature,while Tutoplast grafts had a higher incidence of postoperativeerectile dysfunction.BMG had the highest percentage of postoperative penile straightening.Overall,the TachoSil graft showed thebest performance when preoperative curvature is taken into account.Based on the available literature,BMG appear to be the mosteffective for penile curvature correction in PD,but this is offset by the requirement for low preoperative curvature.The TachoSilgraft shows the best overall performance when preoperative curvature is considered.Comparative randomized clinical trials arestill needed to determine graft superiority.