Skip to main content
SpringerLink
Log in

Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology

World Journal of Urology volume 40, pages 1091–1110 (2022)Cite this article

Abstract

Purpose

Transurethral resection (TURP) and photoselective vaporization of the prostate (PVP) constitute established surgical options to treat benign prostate hyperplasia. We investigated the current literature for simulators that could be used as a tool for teaching urologists alone or within the boundaries of a course or a curriculum.

Methods

A literature search was performed using PubMed, Scopus, EMBASE, and Cochrane Central Register of Controlled Trials—CENTRAL. Search terms included: Simulat*, train*, curricull*, transurethral, TUR*, vaporesect*, laser. The efficacy of different simulators and the impact of different devices, curricula and courses in training and trainee learning curves were the primary endpoints.

Results

Thirty-one studies are selected and presented. Validated virtual reality TURP simulators are the UW VR, PelvicVision, Uro-Trainer, and TURPsim™. Validated synthetic TURP models are Dr. K. Forke's TURP trainer, Bristol TURP trainer, different tissue prostate models, and 3D-printed phantoms. The Myo Sim PVP and the GreenLightTM are sufficiently validated PVP simulators. Several TURP and PVP training curricula have been developed and judged as applicable. Finally, the TURP modules of the European Urology Residents Education Programme (EUREP) Hands-on Training course and the Urology Simulation Bootcamp Course (USBC) are the most basic annual TURP courses identified in the international literature.

Conclusions

Simulators and courses or curricula are valuable learning and training TURP/PVP tools. The existent models seem efficient, are not always adequately evaluated and accepted. As part of training curricula and training courses, the use of training simulators can significantly improve quality for young urologists' education and clinical practice.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1

References

  1. Irwin DE, Kopp ZS, Agatep B, Milsom I, Abrams P (2011) Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int 108(7):1132–1138. https://doi.org/10.1111/j.1464-410X.2010.09993.x

    Article  PubMed  Google Scholar 

  2. Zang YC, Deng XX, Yang DR, Xue BX, Xu LJ, Liu XL, Zhou YB, Shan YX (2016) Photoselective vaporization of the prostate with GreenLight 120-W laser versus transurethral resection of the prostate for benign prostatic hyperplasia: a systematic review with meta-analysis of randomized controlled trials. Lasers Med Sci 31(2):235–240. https://doi.org/10.1007/s10103-015-1843-1

    Article  PubMed  Google Scholar 

  3. Liberale F, Muir GH, Walsh K, Krishnamoorthy R (2011) GreenLight laser prostatectomy: a safe and effective treatment for bladder outlet obstruction by prostate cancer. BJU Int 107(5):772–776. https://doi.org/10.1111/j.1464-410X.2010.09584.x

    Article  PubMed  Google Scholar 

  4. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58(3):384–397. https://doi.org/10.1016/j.eururo.2010.06.005

    Article  PubMed  Google Scholar 

  5. Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S (2015) A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol 67(6):1066–1096. https://doi.org/10.1016/j.eururo.2014.06.017

    Article  PubMed  Google Scholar 

  6. Malek RS, Kuntzman RS, Barrett DM (2005) Photoselective potassium-titanyl-phosphate laser vaporization of the benign obstructive prostate: observations on long-term outcomes. J Urol 174(4 Pt 1):1344–1348. https://doi.org/10.1097/01.ju.0000173913.41401.67

    Article  PubMed  Google Scholar 

  7. Cameron JL (1997) William Stewart Halsted. Our surgical heritage. Ann Surg 225(5):445–458. https://doi.org/10.1097/00000658-199705000-00002

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Reznick RK, MacRae H (2006) Teaching surgical skills-changes in the wind. N Engl J Med 355(25):2664–2669. https://doi.org/10.1056/NEJMra054785

    Article  CAS  PubMed  Google Scholar 

  9. Kallidonis P, Peteinaris A, Ortner G, Somani BK, Veneziano D, Tunc L, Gözen AS, Liatsikos E, Tokas T (2021) Simulation models and training curricula for training in endoscopic enucleation of the prostate: a systematic review from ESUT. Turk J Urol 47(4):250–259

    Article  Google Scholar 

  10. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (eds) (2019) Cochrane handbook for systematic reviews of interventions version 6.0 (updated July 2019). Cochrane. www.training.cochrane.org/handbook

  11. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  12. Ballaro A, Briggs T, Garcia-Montes F, MacDonald D, Emberton M, Mundy AR (1999) A computer generated interactive transurethral prostatic resection simulator. J Urol 162(5):1633–1635

    Article  CAS  Google Scholar 

  13. Brewin J, Ahmed K, Khan MS, Jaye P, Dasgupta P (2014) Face, content, and construct validation of the Bristol TURP trainer. J Surg Educ 71(4):500–505. https://doi.org/10.1016/j.jsurg.2014.01.013

    Article  PubMed  Google Scholar 

  14. Bright E, Vine S, Wilson MR, Masters RS, McGrath JS (2012) Face validity, construct validity and training benefits of a virtual reality TURP simulator. Int J Surg 10(3):163–166. https://doi.org/10.1016/j.ijsu.2012.02.012

    Article  PubMed  Google Scholar 

  15. Bright E, Vine SJ, Dutton T, Wilson MR, McGrath JS (2014) Visual control strategies of surgeons: a novel method of establishing the construct validity of a transurethral resection of the prostate surgical simulator. J Surg Educ 71(3):434–439. https://doi.org/10.1016/j.jsurg.2013.11.006

    Article  PubMed  Google Scholar 

  16. Choi E, Adams F, Palagi S, Gengenbacher A, Schlager D, Müller PF, Gratzke C, Miernik A, Fischer P, Qiu T (2020) A high-fidelity phantom for the simulation and quantitative evaluation of transurethral resection of the prostate. Ann Biomed Eng 48(1):437–446. https://doi.org/10.1007/s10439-019-02361-7

    Article  PubMed  Google Scholar 

  17. Ebbing J, Schostak M, Steiner U, Stier K, Neymeyer J, Miller K, Baumunk D (2011) Novel low-cost prostate resection trainer-description and preliminary evaluation. Int J Med Robot 7(3):367–373. https://doi.org/10.1002/rcs.407

    Article  PubMed  Google Scholar 

  18. Hou S, Ross G, Tait I, Halliday P, Tang B (2017) Development and validation of a novel and cost-effective animal tissue model for training transurethral resection of the prostate. J Surg Educ 74(5):898–905. https://doi.org/10.1016/j.jsurg.2017.03.004

    Article  PubMed  Google Scholar 

  19. Hudak SJ, Landt CL, Hernandez J, Soderdahl DW (2010) External validation of a virtual reality transurethral resection of the prostate simulator. J Urol 184(5):2018–2022. https://doi.org/10.1016/j.juro.2010.06.141

    Article  PubMed  Google Scholar 

  20. Källström R, Hjertberg H, Kjölhede H, Svanvik J (2005) Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate. Scand J Urol Nephrol 39(4):313–320. https://doi.org/10.1080/00365590510031246

    Article  PubMed  Google Scholar 

  21. Källström R, Hjertberg H, Svanvik J (2010) Construct validity of a full procedure, virtual reality, real-time, simulation model for training in transurethral resection of the prostate. J Endourol 24(1):109–115. https://doi.org/10.1089/end.2009.0114

    Article  PubMed  Google Scholar 

  22. Källström R, Hjertberg H, Svanvik J (2010) Impact of virtual reality-simulated training on urology residents’ performance of transurethral resection of the prostate. J Endourol 24(9):1521–1528. https://doi.org/10.1089/end.2009.0667

    Article  PubMed  Google Scholar 

  23. Kumar PV, Gomes MP, Davies BL, Timoney AG (2002) A computer assisted surgical trainer for transurethral resection of the prostate. J Urol 168(5):2111–2114. https://doi.org/10.1097/01.ju.0000034468.80053.22

    Article  CAS  PubMed  Google Scholar 

  24. Mishra S, Kurien A, Ganpule A, Veeramani M, Sabnis RB, Desai M (2010) Face and content validity of transurethral resection of prostate on Uro Trainer: is the simulation training useful? J Endourol 24(11):1839–1843. https://doi.org/10.1089/end.2009.0612

    Article  PubMed  Google Scholar 

  25. Rashid HH, Kowalewski T, Oppenheimer P, Ooms A, Krieger JN, Sweet RM (2007) The virtual reality transurethral prostatic resection trainer: evaluation of discriminate validity. J Urol 177(6):2283–2286. https://doi.org/10.1016/j.juro.2007.01.120

    Article  PubMed  Google Scholar 

  26. Rasyid N, Putra HWK, Birowo P, Wahyudi I, Mochtar CA, Hamid A (2020) TUR-P phantom for resident surgical training: food-based design as a human mimicking model of the prostate. World J Urol. https://doi.org/10.1007/s00345-020-03085-3

    Article  PubMed  Google Scholar 

  27. Schout BM, Bemelmans BL, Martens EJ, Scherpbier AJ, Hendrikx AJ (2009) How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures? J Urol 181(3):1297–1303. https://doi.org/10.1016/j.juro.2008.10.169 (discussion 1303)

    Article  PubMed  Google Scholar 

  28. Schulz GB, Grimm T, Kretschmer A, Stief CG, Jokisch F, Karl A (2020) Benefits and limitations of transurethral resection of the prostate training with a novel virtual reality simulator. Simul Healthc 15(1):14–20. https://doi.org/10.1097/sih.0000000000000396

    Article  PubMed  Google Scholar 

  29. Sweet R, Kowalewski T, Oppenheimer P, Weghorst S, Satava R (2004) Face, content and construct validity of the University of Washington virtual reality transurethral prostate resection trainer. J Urol 172(5 Pt 1):1953–1957. https://doi.org/10.1097/01.ju.0000141298.06350.4c

    Article  CAS  PubMed  Google Scholar 

  30. Tjiam IM, Berkers CH, Schout BM, Brinkman WM, Witjes JA, Scherpbier AJ, Hendrikx AJ, Koldewijn EL (2014) Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc 9(5):288–294. https://doi.org/10.1097/sih.0000000000000041

    Article  PubMed  Google Scholar 

  31. Zhu H, Zhang Y, Liu JS, Wang G, Yu CF, Na YQ (2013) Virtual reality simulator for training urologists on transurethral prostatectomy. Chin Med J (Engl) 126(7):1220–1223

    Google Scholar 

  32. Angulo JC, Arance I, García-Tello A, Las Heras MM, Andrés G, Gimbernat H, Lista F, Ramón de Fata F (2014) Virtual reality simulator for training on photoselective vaporization of the prostate with 980 nm diode laser and learning curve of the technique. Actas Urol Esp 38(7):451–458. https://doi.org/10.1016/j.acuro.2014.02.013

    Article  CAS  PubMed  Google Scholar 

  33. Aydin A, Muir GH, Graziano ME, Khan MS, Dasgupta P, Ahmed K (2015) Validation of the GreenLightTM Simulator and development of a training curriculum for photoselective vaporisation of the prostate. BJU Int 115(6):994–1003. https://doi.org/10.1111/bju.12842

    Article  PubMed  Google Scholar 

  34. Kishore TA, Beddingfield R, Holden T, Shen Y, Reihsen T, Sweet RM (2009) Task deconstruction facilitates acquisition of transurethral resection of prostate skills on a virtual reality trainer. J Endourol 23(4):665–668. https://doi.org/10.1089/end.2008.0531

    Article  PubMed  Google Scholar 

  35. Sweet R, Konchada V, Jain S, Zhang N, Zhou X, Burke D, Wong C, Carson C, Roehrborn C, Shen Y (2011) 1487 training laser prostate surgery with an advanced simulation based curriculum: the Victor® greenlight trainer. J Urol 185(4S):e596. https://doi.org/10.1016/j.juro.2011.02.1445

    Article  Google Scholar 

  36. Shamim Khan M, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, Ahmed M, Jaye P, Dasgupta P (2013) Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 111(3):518–523. https://doi.org/10.1111/j.1464-410X.2012.11204.x

    Article  PubMed  Google Scholar 

  37. Noureldin YA, Elkoushy MA, Aloosh M, Carrier S, Elhilali MM, Andonian S (2016) Objective structured assessment of technical skills for the photoselective vaporization of the prostate procedure: a pilot study. J Endourol 30(8):923–929. https://doi.org/10.1089/end.2016.0270

    Article  PubMed  Google Scholar 

  38. Kailavasan M, Berridge C, Athanasiadis G, Gkentzis A, Rai B, Jain S, Biyani CS, Nabi G (2020) Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course. World J Urol. https://doi.org/10.1007/s00345-020-03104-3

    Article  PubMed  Google Scholar 

  39. Biyani CS, Hanchanale V, Rajpal S, Jain S, Garthwaite M, Cartledge J, Somani B, Cornford P, Gowda B, Koenig P, Reeves F, Rogawski K, Myatt A, Eardley I, Terry T (2017) First urology simulation boot camp in the United Kingdom. Afr J Urol 23(3):258–267. https://doi.org/10.1016/j.afju.2017.03.002

    Article  Google Scholar 

  40. Kailavasan M, Hanchanale V, Rajpal S, Morley R, McLlhenny C, Somani B, Nabi G, Gowda R, Jain S, Biyani CS, Myatt A (2019) A method to evaluate trainee progression during simulation training at the urology simulation boot camp (USBC) course. J Surg Educ 76(1):215–222. https://doi.org/10.1016/j.jsurg.2018.06.020

    Article  PubMed  Google Scholar 

  41. Somani BK, Van Cleynenbreugel B, Gozen A, Palou J, Barmoshe S, Biyani S, Gaya JM, Hellawell G, Pini G, Oscar FR, Sanchez Salas R, Macek P, Skolarikos A, Wagner C, Eret V, Haensel S, Siena G, Schmidt M, Klitsch M, Vesely S, Ploumidis A, Proietti S, Kamphuis G, Tokas T, Geraghty R, Veneziano D (2019) The European Urology Residents Education Programme Hands-on Training Format: 4 years of hands-on training improvements from the European School of Urology. Eur Urol Focus 5(6):1152–1156. https://doi.org/10.1016/j.euf.2018.03.002

    Article  PubMed  Google Scholar 

  42. Young M, Kailavasan M, Taylor J, Cornford P, Colquhoun A, Rochester M, Hanchanale V, Somani B, Nabi G, Garthwaite M, Gowda R, Reeves F, Rai B, Doherty R, Gkentzis A, Athanasiadis G, Patterson J, Wilkinson B, Myatt A, Biyani CS, Jain S (2019) The success and evolution of a urological “Boot Camp” for newly appointed UK urology registrars: incorporating simulation, nontechnical skills and assessment. J Surg Educ 76(5):1425–1432. https://doi.org/10.1016/j.jsurg.2019.04.005

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria

    Theodoros Tokas, Gernot Ortner & Udo Nagele

  2. Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria

    Theodoros Tokas, Gernot Ortner, Thomas Herrmann & Udo Nagele

  3. Department of Urology, University of Patras, Patras, Greece

    Angelis Peteinaris & Panagiotis Kallidonis

  4. Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK

    Bhaskar Kumar Somani

  5. Department of Urology, Kantonsspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas Herrmann

  6. Department of Urology, Riuniti Hospital, Reggio Calabria, Italy

    Domenico Veneziano

  7. Department of Urology, SLK Kliniken, Klinikum Heilbronn, Heilbronn, Germany

    Ali Serdar Gözen

Authors
  1. Theodoros Tokas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gernot Ortner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelis Peteinaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bhaskar Kumar Somani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Herrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Udo Nagele
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Domenico Veneziano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ali Serdar Gözen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Panagiotis Kallidonis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TT: protocol/project development, manuscript writing. GO, AP: data collection, data analysis. BKS, TRWH, UN, DV, ASG: interpreting data, manuscript revision. PK: manuscript writing.

Corresponding author

Correspondence to Theodoros Tokas.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

This review does not involve human participants and/or animals.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tokas, T., Ortner, G., Peteinaris, A. et al. Simulation training in transurethral resection/laser vaporization of the prostate; evidence from a systematic review by the European Section of Uro-Technology. World J Urol 40, 1091–1110 (2022). https://doi.org/10.1007/s00345-021-03886-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-021-03886-0

Keywords

search

Navigation