Education, Simulation & Virtual Reality

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 241

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

Miss Kate Quirke - King's College London, MRC Centre for Transplantation, London

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    Abdullatif Aydin

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

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      Catherine Lovegrove

      Foundation Doctor
      West Middlesex Hospital

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        Matthew Bultitude

        Consultant Urologist
        Guy's and St. Thomas Hospital

        Consultant Urologist at Guy's and St. Thomas' in London, UK.
        Specialist interest in stone disease.
        Associate Editor, BJUI
        @mattbultitude

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          John Denstedt

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            Laurian B. Dragos

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

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              Sven Lahme

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                Howard Marsh

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                  Jake Patterson

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                    Giovannalberto Pini

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                      Kemal Sarica

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

                      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,
                      2003
                      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:
                      National
                      • Turkish Urological Association
                      • Turkish Endourological Society
                      • Pediatric Urology Association
                      • Turkish Cancer and Research Association
                      • Board member of “Turkish Endourological Society”


                      International
                      • 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)

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                        C Seitz

                        Urologist
                        Medical University of Vienna, Urology, Vienna, Austria

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                          Andreas Skolarikos

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

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                            Bhaskar K. Somani

                            Consultant Urologist, Associate Professor
                            University Hospital Southampton , U.K

                            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.

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                              Guohua Zeng

                              Vice Director
                              The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

                              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.

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                                Shamim Khan

                                Consultant
                                Department of Urology, Guy's and St. Thomas' NHS Foundation Trust

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                                  Prokar Dasgupta

                                  MRC Centre for Transplantation, King's College London

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                                    Kamran Ahmed

                                    MRC Centre for Transplantation, King's College London

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