CUA 2018: Development and Initial Validation of a Low-Cost Ultrasound-Compatible Suprapubic Catheter Insertion Training Simulator

Halifax, Nova Scotia ( Yuding Wang, MD, and colleagues from McMaster University presented their initial results of an ultrasound compatible suprapubic catheter insertion training simulator at the CUA 2018 annual meeting. Patient’s may require an urgent suprapubic catheter for urinary retention from several etiologies, and bedside suprapubic catheterization is a fundamental skill required of all urology trainees. Ultrasound guidance during bedside suprapubic catheterization insertion can minimize complications, and its use is recommended in clinical practice guidelines1. Anecdotally, this is particularly important when encountering a patient with prior abdominal or pelvic surgery when there is concern for loops of bowel in the potential trajectory of the suprapubic catheter. However, a lack of affordable simulation models and the unpredictability of bedside suprapubic catheterizations make learning this procedure difficult for trainees. Often these procedures are performed in the middle of the night when appropriate upper-level assistance may not be readily available. The objective of Dr. Wang’s study was to develop and initially validate a low-cost ultrasound-compatible bedside suprapubic catheterization simulation model that allows trainees to safely and deliberately practice suprapubic catheterization while acquiring skills that are transferable to the patient bedside.

For this study, seven staff urologists and four interventional radiologists conducted a suprapubic catheterization using the model with ultrasound guidance. To assess for face and content validity, each participant rated the model (using a five-point Likert scale) on three domains: anatomic realism, usefulness as a training tool, and overall reaction. The suprapubic catheterization simulator consists of eight components (total cost ~$48 CAD):

  1. Bladder – 3L normal saline irrigation bag under pressure via tourniquet (cost: $18)
  2. Rectum – 100mL normal saline bag injected with red food coloring (cost: $5)
  3. Skin layer – silicone skin model without layers purchased from a medical/surgical simulation company (cost: $10)
  4. Subcutaneous tissue layer – ultrasound compatible agar gelatin in a 100mm x 100mm mold which is 15 mm thick (cost: $1)
  5. Housing – a shoebox sized plastic box with a snap on plastic lid to provide stability. A square portion of the lid is cut out to simulate the suprapubic catheterization site (cost: $2)
  6. Suprapubic catheter introducer kit – obtained from medical supplier (cost: $5)
  7. Ultrasound gel – obtained from medical supplier (cost: $6)
  8. Drape – reusable sterile draping to cover the box, with a hole cut into the drape to expose the simulated suprapubic catheterization site (cost: $1)
The suprapubic catheterization simulator with the catheter inserted is depicted:
suprapubic catheterization simulator

The participants for this study were in practice for a median of 10 years (range 2-23), and the median number of suprapubic catheterizations performed was 50. Anatomic realism scored a mean of 4.1, with a mean of 4.0 for sonographic realism. Usefulness as a training tool scored a mean of 4.3, and the mean for overall reaction was 4.4. Participants strongly agreed that the model should be incorporated into urology residency (mean 4.4), the skills are transferable to patients (mean 4.3), and its use would improve trainee confidence (mean 4.6). 

The strength of the current study is the low-cost model, which can be used multiple times during one session. A possible limitation is that this study was performed on staff physicians with previous experience placing suprapubic catheters and has yet to be trialed on urologic trainees. The authors concluded that this novel, low-cost, easily reproducible, ultrasound-compatible suprapubic catheterization training simulator received positive evaluations from staff urologists and interventional radiologists as a useful model for teaching bedside ultrasound-guided suprapubic catheter insertion. Dr. Wang notes that this model will be integrated into their institution’s next annual urology boot camp curriculum, which will allow for further evaluation. 

Presented by: Yuding (Ding) Wang, MD, McMaster University, Hamilton, Ontario, Canada
Co-Authors: Udi Blankstein1, Jen Hoogenes1, Ali Al-Hashimi1, Edward Matsumoto1
1Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada

1. Wessells H, Angermeier KW, Elliott SP, et al. Male urethral stricture: AUA guideline. Linthicum (MD): American Urological Association Education and Research, Inc.; 2016 Apr. 34

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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