Development and Validation of a Simulation Model for Ureteral Stent Placement

Importance: Currently, there are no validated training models for cystoscopy with ureteral stent placement.

Objectives: The objectives of this study were to develop and validate a novel endoscopic simulation model for training in ureteral stent placement.

Study design: A low-cost, low-fidelity training model was developed to simulate ureteral stent placement. Recruited participants were divided into 3 groups: novices (postgraduate year 3/4 gynecology residents), advanced learners (urogynecology and reconstructive pelvic surgery fellows), and experts (urology residents, urogynecology faculty, and urology faculty). Construct validity was measured using de-identified video-recorded performances on the model, which were evaluated by 2 expert reviewers using validated scales (Global Operative Assessment of Laparoscopic Skills [GOALS], Global Rating Scale [GRS]) and procedure-specific metrics.

Results: The model was created using a hollow Styrofoam sphere, plastic tubing from a retropubic sling, and a silicone pacifier. Thirty-six surgeons were assessed performing the procedure using the model with cystoscopic equipment. The experts (n = 12) performed significantly better than the advanced learners (n = 17) and novices (n = 7) in total scores (max 75, median [IQR]: 75 [75-75], 61 [56.5-68.5], 45 [43-46], respectively; P < 0.001) and within each individual scale domain. Increasing experience with ureteral stent placement had a significant correlation (P < 0.001) with better performance on the model. A minimum total passing score of 63 was established. On post simulation assessment, most participants "agreed" or "strongly agreed" that the model closely approximates the feel of ureteral stent placement.

Conclusion: This ureteral stenting simulation model is easy to construct, affordable, and reproducible. The model is valid and reliable for practicing the procedure in preparation for live surgery.