Transurethral resection of bladder tumor (TURBT) is one of the procedures most often performed by trainee urologists. ENTRY is a cooperative partnership aimed at improving the training of urology residents.
Metrics for TURBT were published after a Delphi consensus process involving experts. The aim of this study was to assess the reliability and construct validity (via known-group and convergent validity) of objective metrics for characterizing the intraoperative performance of TUTBT as optimal versus suboptimal.
Thirty videos of TURBT performed by experts (n = 15) and novices (n = 15) were evaluated by three experienced urologists trained to reliably and independently score TURBT performance using the metrics previously developed. The videos were anonymized and the assessors were blinded to the surgeon, hospital, and expertise. The inter-rater reliability score was assessed and surgical errors were reported using a dummy dichotomous variable. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was applied for between-group comparisons.
The median number of overall errors was 1 (interquartile range [IQR] 0-2) in the expert group versus 5 (IQR 4-7) in the novice group, with a median difference of -4 errors (95% confidence interval [CI] -5 to -3; p = 0.001). The median number of noncritical errors per TURBT procedure was 1 (IQR 0-2) in the expert group versus 3 (IQR 2-4) in the novice group, with a median difference of -2 errors (95% CI -3 to -1; p = 0.001). The median number of critical errors was 0 (IQR 0-1) for the expert group versus 2 (IQR 2-3) for the novice group, with a median difference of -2 errors (95% CI -3 to -1; p = 0.001). We compared the performance of the expert and novice groups, which revealed a concordance index of 0.6 for noncritical errors, 0.73 for critical errors, and 0.66 for overall errors.
Our study demonstrates the construct validity of metrics developed for the quality of TURBT performance. This represents a further step in establishing a quality-assured structured and standardized training program for TURBT.
European urology focus. 2025 Dec 17 [Epub ahead of print]
Pietro Diana, Marco Paciotti, Nicola Frego, Andrea Gallioli, Francesco Di Bello, Paola Arena, Alessandro Uleri, Federica Sordelli, Giuseppe Garofano, Lucia Dieguez, Omid Sedigh, Paolo Gontero, Anthony Gallagher, Alex Mottrie, Joan Palou, Alberto Breda, Nicolo Maria Buffi
Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain. Electronic address: ., Department of Biochemical Science, Humanitas University, Milan, Italy; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Milan, Italy., Department of Urology, Humanitas Mater Domini, Castellanza, Milan, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain., Department of Urology, Fundació Puigvert, Barcelona, Spain; Urology Unit, Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, La Croix du Sud Hôpital, Quint Fonsegrives, France., Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Urology, Humanitas Gradenigo Hospital, Torino, Italy., Department of Urology, Fundació Puigvert, Barcelona, Spain., Department of Urology, Humanitas Gradenigo Hospital, Torino, Italy., Department of Urology, Città della Salute e della Scienza, University of Torino School of Medicine, Torino, Italy., ORSI Academy, Melle, Belgium.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/41412888