Performance Improvement (Pi) score: an algorithm to score Pi objectively during E-BLUS hands-on training sessions. A European Association of Urology, Section of Uro-Technology (ESUT) project.

OBJECTIVE: To evaluate the variability of subjective tutor performance improvement (Pi) assessment and to compare it with a novel measurement algorithm: the Pi score. MATERIALS AND METHODS: The Pi-score algorithm considers time measurement and number of errors from two different repetitions (first and fifth) of the same training task and compares them to the relative task goals, to produce an objective score. We collected data during eight courses on the four European Association of Urology training in Basic Laparoscopic Urological Skills (E-BLUS) tasks. The same tutor instructed on all courses. Collected data were independently analysed by 14 hands-on training experts for Pi assessment. Their subjective Pi assessments were compared for inter-rater reliability. The average per-participant subjective scores from all 14 proctors were then compared with the objective Pi-score algorithm results. Cohen's κ statistic was used for comparison analysis. RESULTS: A total of 50 participants were enrolled. Concordance found between the 14 proctors' scores was the following: Task 1, κ = 0.42 (moderate); Task 2, κ = 0.27 (fair); Task 3, κ = 0.32 (fair); and Task 4, κ = 0.55 (moderate). Concordance between Pi-score results and proctor average scores per participant was the following: Task 1, κ = 0.85 (almost perfect); Task 2, κ = 0.46 (moderate); Task 3, κ = 0.92 (almost perfect); Task 4 = 0.65 (substantial). CONCLUSION: The present study shows that evaluation of Pi is highly variable, even when formulated by a cohort of experts. Our algorithm successfully provided an objective score that was equal to the average Pi assessment of a cohort of experts, in relation to a small amount of training attempts.

Positioning invasive versus noninvasive urodynamics in the assessment of bladder outlet obstruction.

PURPOSE OF REVIEW: To provide evidence of promising tests to noninvasively diagnose bladder outlet obstruction (BOO) in men with benign prostatic hyperplasia. RECENT FINDINGS: Pressure-flow studies are usually performed to prove BOO prior to prostatectomy. However, pressure-flow studies are invasive, expensive, time consuming, and potentially harmful to the patient due to unwarranted side-effects. In the last decade, attempts were made to diagnose BOO noninvasively. Ultrasound-derived measurements such as bladder or detrusor wall thickness or intravesical prostatic protrusion and urodynamic-derived measurements such as isovolumetric bladder pressure by the condom catheter or penile cuff tests show promising results. Likelihood ratios of all tests were calculated for this study and indicated a good ability to detect BOO. CONCLUSION: Noninvasive measurements of bladder/detrusor wall thickness, intravesical prostatic protrusion, or isovolumetric bladder pressure might replace invasive pressure-flow studies in the future if only information about BOO is needed. These tests are applicable for the majority of patients with lower urinary tract symptoms and suspected BOO. However, urodynamic investigations are still indicated in patients requiring detailed information about the bladder filling and voiding phases and to assess the precise cause of lower urinary tract symptoms.