Development and assessment of an ex-vivo bench model aimed at laparoscopic ureteric reconstructive techniques.

INTRODUCTION/BACKGROUND: Reconstructive and ablative urologic techniques require special technical mastery, especially the intracorporeal suturing. OBJECTIVE: To report the subjective evaluation of a versatile ex-vivo model aimed to practice laparoscopic ureteric reconstructive techniques (LURT) on box-trainer. STUDY DESIGN: The model is a continuous portion of porcine urinary bladder ("dilated pelvis"), the vesico-ureteral joint ("stenosis") and healthy ureter. All 127 participants (n = 119 urologists and n = 8 paediatric surgeons) performed on the model laparoscopic Anderson-Hynes dismembered pyeloplasty, and then, in the animal model, different LURT procedures (ureteroneocystostomy, ureteric reimplantation and/or dismembered pyeloplasty). The model was subjectively evaluated (face and content validity), through a 12 items questionnaire, based on a Likert scale (1-5 points) and a global question (1-10 points). RESULTS: The total mean rating for 11/12 items was very high (>4points). Only one was rated under 3 points. The overall total mean rating from 1 to 10 points was very high (9.19 ± 0.82 points). In 10/12 items, expert's feedback (content validity) prevailed over non-experts (face validity). DISCUSSION/CONCLUSION: The model was highly accepted for the practice of LURT techniques. Additionally, it is cost-effective, easy to assemble, ethically considerate, and realistic.

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

[Transrectal ultrasonography in the assessment of patients after radical prostatectomy. Normal and pathologic ultrasonography anatomy of vesico-urethral anastomosis]. / La ecografía transrectal en la evaluación de los pacientes después de prostatectomía radical. Ecoanatomía normal y patológica de la anastomosis vésico-uretral.

OBJECTIVE: To determine the ultrasound characteristics of the vesico-urethral anastomotic complex in patients with radical prostatectomy to separate normal prostate fossae from those affected by local recurrence or residual tumour. MATERIAL AND METHODS: Between January 1998 and June 1999 15 ultrasound guided transrectal biopsies of vesico-urethral anastomosis or prostate fossae were performed in patients with radical prostatectomy. The selection criteria to perform puncture in these patients were a negative extension study (abdominal-pelvic CT and bone scan), PSA higher than 0.4 ng/mL and/or suspicious DRE. The study was completed with 10 transrectal ultrasound (TRU) after radical prostatectomy in patients with normal PSA and DRE. TRU parameters in patients with tumour-positive biopsies were compare to those from patients with negative biopsies and those obtained from TRU in patients with both normal PSA and normal DRE. RESULTS: The ultrasound parameters that best described prostate fossa abnormalities were the presence of hypoechoic masses or nodes and the integrity or not of the retro-anastomotic fat layer. When a hypoechoic mass or node was found at the anastomosis level, 80% biopsies were positive for tumour local recurrence. The percentage increases when changes are seen at the retro-anastomotic fat layer. CONCLUSIONS: In spite of a good correlation between ultrasound abnormalities and positive biopsies, ultrasound findings from the vesico-urethral anastomosis in patients with radical prostatectomy are not well defined. Nodes or ultrasound irregularities can exist in normal prostate fossae as well as normal anastomosis ultrasound in the presence of tumoral relapses. We believe TRU of vesico-urethral anastomosis to be the best method available to evaluate local recurrence or tumoral persistence after radical prostatectomy.