Face and content validation of laser enucleation of prostate simulation model: an EAU European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group study.

INTRODUCTION

Laser enucleation of the prostate (LEP) has become a standard treatment for benign prostatic obstruction, yet its adoption is limited by a steep learning curve and a lack of validated training models. This study aimed to evaluate the face and content validity of a bench-top simulator specifically developed for LEP training within the framework of the European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group.

METHODS

Fourteen expert endourologists assessed the simulator during the European Urology Residents Education Programme (EUREP) 2025. Face and content validity were evaluated using 4-point Likert questionnaires, structured using the ESU validation framework. Descriptive statistics and content validity indices (I-CVI, S-CVI/Ave, S-CVI/UA) were calculated to assess agreement across anatomical, procedural, and educational domains.

RESULTS

Face validity scores were high across all items (mean 3.57-3.86; ≥90% agreement). The overall S-CVI/Ave was 0.85 and S-CVI/UA 0.47. Domain-specific analysis showed strong content validity for procedural steps (S-CVI/Ave = 0.89) and educational/global domains (0.95), moderate validity for essential anatomy (0.81), and lower ratings for intraoperative conditions (0.69), primarily due to the absence of bleeding simulation. When restricted to core domains (procedural + educational), S-CVI/Ave improved to 0.91.

CONCLUSION

The simulator demonstrated strong face and content validity. Expert ratings indicated favorable perceptions of its realism, procedural similarity, and educational utility. These findings suggest that the simulator may be a useful component of a structured transurethral procedural training curriculum, although further construct validation is needed.