Urology · 2025
International Expert Consensus on Development of a State of the Art Male Perineal Anatomy Simulation Model for Urethroplasty and Artificial Urinary Sphincter Insertion.
СтатьяConsensus StatementНазвание и аннотация: Перевод в очереди
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Cohen Andrew J, Saba Patrick, Abalajon Mark Toto, Anderson Katherine T, Baradaran Nima, Benson Cooper, Boysen William R, Breyer Benjamin N, Burnett Arthur L, Campos Felix, Hampson Lindsay, Higuchi Ty T, Johnsen Niels V, Lumen Nicolaas, Nikolavsky Dmitriy, Pariser Joseph, Simhan Jay, Vanni Alex J, Warner Nick, James Wright E, Ghazi Ahmed
Аннотация
OBJECTIVE: To create a high-fidelity, non-biohazardous, simulation model to train for urethroplasty or placement of artificial urinary sphincters (AUS) in the bulbar urethra. Narrow, deep and dark: the male perineum is a technically difficult area for learners to gain surgical skills and confidence.
METHODS: Nineteen high volume reconstructive urologists were recruited to complete a Delphi process to reach an expert consensus on parameters and design specifications for simulation. Consensus (>80%) was reached regarding procedural realism, anatomical realism, and educational effectiveness. Using validated 3D printing and hydrogel molding techniques, we fabricated a model incorporating expert determined aspects. Prototypes were sent to 11 (58%) of the experts who performed skin-to-skin AUS and urethroplasty simulations. Autopsy and questionnaires evaluated the model to determine if the consensus-defined deliverables were met, and confirm the realism of anatomy during the procedures.
RESULTS: Overall, experts agreed the model could function as a training tool for urethral surgery. 91%, 82%, and 100% agreed the model procedurally replicates the steps necessary to complete urethral exposure, tissue textures/behaviors, and overall anatomical relationships, respectively. Experts agreed on the fidelity of perineal incision/exposure (91%), urethral dissection/exposure (100%), placement of AUS pump (89%) urethral cuff measurement (100%) urethral spatulation (91%), and urethral mucosal suture placement (91%).
CONCLUSION: We successfully designed a high-fidelity, non-biohazardous, simulation model for urethral procedures in the perineum utilizing expert consensus. The model displayed high procedural and anatomical realism, and has potential as an effective educational platform. This as a groundbreaking tool to enhance training in complex urethral surgeries, bridging the gap between theory and practice.
METHODS: Nineteen high volume reconstructive urologists were recruited to complete a Delphi process to reach an expert consensus on parameters and design specifications for simulation. Consensus (>80%) was reached regarding procedural realism, anatomical realism, and educational effectiveness. Using validated 3D printing and hydrogel molding techniques, we fabricated a model incorporating expert determined aspects. Prototypes were sent to 11 (58%) of the experts who performed skin-to-skin AUS and urethroplasty simulations. Autopsy and questionnaires evaluated the model to determine if the consensus-defined deliverables were met, and confirm the realism of anatomy during the procedures.
RESULTS: Overall, experts agreed the model could function as a training tool for urethral surgery. 91%, 82%, and 100% agreed the model procedurally replicates the steps necessary to complete urethral exposure, tissue textures/behaviors, and overall anatomical relationships, respectively. Experts agreed on the fidelity of perineal incision/exposure (91%), urethral dissection/exposure (100%), placement of AUS pump (89%) urethral cuff measurement (100%) urethral spatulation (91%), and urethral mucosal suture placement (91%).
CONCLUSION: We successfully designed a high-fidelity, non-biohazardous, simulation model for urethral procedures in the perineum utilizing expert consensus. The model displayed high procedural and anatomical realism, and has potential as an effective educational platform. This as a groundbreaking tool to enhance training in complex urethral surgeries, bridging the gap between theory and practice.