Training in ureteroscopy for urolithiasis

Objectives:
To provide an insight into the current status of semi-rigid and flexible ureteroscopy, following new curricula for training methods, including training with models, virtual reality and active mentoring.

Methods:
We systematically reviewed previous reports, including articles in English identified using the following strategy: (‘ureteroscopy’[Mesh]) or (‘urolithiasis’[Mesh]) AND (‘education’[Mesh]), or (‘teaching’[Mesh]). Abstracts submitted at congresses were not included. Relevant articles that were identified as references in the retrieved articles were also included.

Results:
The terms (‘urolithiasis’[Mesh] AND ‘education’[Mesh]) retrieved 106 articles, of which five were included. The terms (‘urolithiasis’[Mesh] AND ‘teaching’[Mesh]) retrieved six articles, of which three were included. The terms (‘ureteroscopy’[Mesh] AND ‘education’[Mesh]) retrieved 29 articles, of which 21 were included. The terms (‘ureteroscopy’[Mesh] AND ‘teaching’[Mesh]) retrieved eight articles, of which seven were included. Remaining articles were found in the reference section of retrieved articles. Finally, 43 articles were included. Four randomised controlled trials with level 1b evidence were included. Currently there is no standard teaching method for ureteroscopy and the number of cases to reach competence has not yet been defined. However, simulation-based training has been shown to be effective, cost-effective, and to increase patient safety.

Conclusions:
Simulators lead to a more rapid acquisition of skills in ureteroscopy than do conventional training methods, and improve the performance of future surgeons. Flexible ureteroscopy simulators are a promising tool for training, and have the advantage of minimising the need for learning the procedures on patients. A didactic and clinical curriculum, including surgical videotape reviews as well as operative mentoring, enables a rapid progression in already experienced endourologists. However, there are few reports specifically addressing the skills necessary for training.