Category: Education, Simulation & Virtual Reality

MP19-15 - Development and Validation of a Modular Training and Assessment Score for Percutaneous Nephrolithotomy

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective : Percutaneous nephrolithotomy (PCNL) remains the first line of treatment for large renal calculi and is considered a technically challenging procedure with multiple steps for urological trainees to learn. To ensure good patient outcomes and decrease the number of adverse events, it is important to standardise training through the creation of a procedure-specific curriculum. The aim of this study was to develop, and content validate an assessment tool for PCNL, taking into consideration the procedure specific risks.

Methods : This longitudinal, observational and prospective international study utilised healthcare failure mode and effect analysis (HFMEA), which was applied to PCNL to develop a final assessment tool. The procedure was systematically mapped out and failure modes for each step of the technique were outlined. 6 surgeons were observed across 3 hospitals for 22.5 hours. Hazard analysis scoring was conducted by 11 urolithiasis experts based on predefined severity and probability scores. The most hazardous stages of PCNL were highlighted. It was determined if the steps were single point weaknesses of the procedure, detectable or if there was an existing control measure in place to prevent the failure mode. Single point weaknesses and those assigned a hazard score > 4 were included in the PCNL assessment tool. The tool was subsequently content validated by 16 experts from 10 countries.

Results : Application of HFMEA identified 64 failure modes; 37 failure modes had a hazard score ≥ 4. After adaptations based on expert feedback the final PCNL Assessment Score was developed. The PCNL Assessment Score contains 10 phases, 21 processes and 47 sub-processes. The phases include: pre-operative preparation, cystoscopy and ureteric catheterisation, patient positioning and stone identification, needle and guidewire insertion, tract dilatation and nephroscope insertion, stone fragmentation, stone extraction, stent insertion and instrument removal, tube insertion and finalising and handover. All participants agreed that the final PCNL Assessment Score contained the most important steps.

Conclusions : As a result of development and content validation, the PCNL assessment tool can be utilised in conjunction with e – learning, non-technical surgical skills and simulation to form a complete PCNL curriculum for urological trainees.

Kate Quirke

Medical Student
Division of Transplantation, Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Campus, London, England, SE1 1UL, United Kingdom
Solihull, England, United Kingdom

Abdullatif Aydin

The Urology Foundation Simulation Research Fellow
MRC Centre for Transplantation, Guy's Hospital, King's College London
London, England, United Kingdom

Catherine Lovegrove

Foundation Doctor
West Middlesex Hospital
London, England, United Kingdom

Matthew Bultitude

Consultant Urologist
Guy's and St. Thomas Hospital
London, England, United Kingdom

John Denstedt

London, Ontario, Canada

Laurian B. Dragos

Consultant Urologist
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
Timisoara, Timis, Romania

Sven Lahme

Pforzheim, Baden-Wurttemberg, Germany

Howard Marsh

Dartford, England, United Kingdom

Jake Patterson

Sheffield, England, United Kingdom

Giovannalberto Pini

Milan, Lombardia, Italy

Kemal Sarica

Professor of Urology
Kafkas University, Faculty of Medicine, Urology Department
Kars, Kars, Turkey

Name, Surname: Kemal SARICA
Academic Title: Professor doctor M.D. , Ph D
Speciality: Urology
Place & Date of Birth: Ardahan / 1963
Graduated Faculty & Year: University of Ankara, Medical School, 1981
Place & Date Residency in Urology: University of Ankara, Medical School ,Department of Urology 1987-1992
Place & Date of Professorship: University of Gaziantep, Medical School, Dept. of Urology,
Foreign languages: English ,German

March 2013-2018 Chair, Department of Urology, Health Sciences University, Dr.Lutfi KIRDAR
Kartal Research and Training Hospital Istanbul / TURKEY
2018 - Chaiman, Department of Urology, Kafkas University Medical School Kars / TURKEY

Professional Publications
• Number of International Publications: 186
• Number of Local Publications: 75
• Number of National Congress Presentations: 342
• Number of International Congress Presentations: 464
• Number of Books/Book Chapters: 12

Memberships in Associations:
• Turkish Urological Association
• Turkish Endourological Society
• Pediatric Urology Association
• Turkish Cancer and Research Association
• Board member of “Turkish Endourological Society”

• American Urological Association (AUA)
• European Urological Association (EAU)
• Eurolithiasis Society (EULIS)
• International Urolithiasis Society ( Board member) (IUS)
• European Society for Pediatric Urology (ESPU)
• Society for Pediatric Urology (SPU)
• International Alliance of Urology ( IAU)

International positions in Associations :
• Chairman : EAU section of Urolithiasis ( EULIS)
• Co-chairman International Alliance of Urolithiasis (IAU)

Member ( Editorial board)
Urolithiasis ( Associate editor)
Archiv.Italian.Urol.Androl ( Editorial board)
Journal of Urology ( Reviewer)
European Urology ( Reviewer)
Pediatric Nephrology ( Reviewer)
Jornal of Endourology ( Reviewer)

C Seitz

Medical University of Vienna, Urology, Vienna, Austria
Vienna, Burgenland, Austria

Andreas Skolarikos

National and Kapodistrian, University of Athens, Athens, Greece
Athens, Attiki, Greece

Bhaskar K. Somani

Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom

Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.

He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.

Guohua Zeng

Vice Director
The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Guangzhou, Guangdong, China (People's Republic)

Professor Zeng is currently the Vice- President of The First Affiliated Hospital of Guangzhou Medical University, Chief of Guangdong key lab of Urology and Chief of Guangzhou Urology Research Institute. Director of certified fellowship program by Endourology Society. President of Guangdong provincial urological association, Associate member of EULIS.
He completed his Master of Urology training in 1992, and his PhD in Urology in 2000. Clinical endourology fellowship at UT Southwestern Medical Center at Dallas in 2007. As an experienced endourologist, he has finished more than 12000 endourological procedures including all kinds of PCNLs, rigid URS and RIRS procedures and Uro-laparoscopic procedures. Leading the development of RIRS in China, he and his group perform more than 1000 RIRS per year. Prof. Zeng and his colleagues also created a unique mini-PCNL technique, namely Chinese Mini-PCNL, in which more than 30000 Chinese Mini-PCNLs surgeries has been performed by Prof. Zeng and his team with good clinical outcome. He also invented a new minimally invasive technique in treatment of middle size renal stones, called “Super-Mini-PCNL (SMP)”.Main innovation in SMP technique is irrigation and suction in the same sheath, it totally solve all problems in Mini-perc technique including low irrigation flow, difficulty in removal stone fragements, high intrarenal pressure and so on, SMP technique has the advantages of a good irrigation, fast stone fragements evacuation and lower intrarenal pressure, So SMP technique is a conception revolution for mini-perc technique.
Prof. Zeng has gained 5 research projects for stone disease from National Natural Science Foundation. More than 100 academic papers have been published in national and international journals, 10 books about stone disease have been published.

Shamim Khan

Department of Urology, Guy's and St. Thomas' NHS Foundation Trust
London, England, United Kingdom

Prokar Dasgupta

MRC Centre for Transplantation, King's College London
London, England, United Kingdom

Kamran Ahmed

MRC Centre for Transplantation, King's College London
London, England, United Kingdom