Validation of the endoscopic stone treatment step 1 (EST-s1): a novel EAU training and assessment tool for basic endoscopic stone treatment skills—a collaborative work by ESU, ESUT and EULIS

  • Domenico VenezianoEmail author
  • Achilles Ploumidis
  • Silvia Proietti
  • Theodoros Tokas
  • Guido Kamphuis
  • Giovanni Tripepi
  • Ben Van Cleynenbreugel
  • Ali Gozen
  • Alberto Breda
  • Joan Palou
  • Kemal Sarica
  • Evangelos Liatsikos
  • Kamran Ahmed
  • Bhaskar K. Somani
  • ESU Training Group
Original Article



The endoscopic stone treatment step 1 (EST s1) protocol has been developed after 2 years of collaborative work between different European Association of Urology (EAU) sections.


In this study, we added construct validity evidence to the EST s1 curriculum.

Materials and methods

The EST-s1 curriculum includes four standardized tasks: flexible cystoscopy, rigid cystoscopy, semi-rigid URS and flexible URS. Validation was performed during the annual 2016 EUREP meeting in Prague. 124 participants provided information on their endoscopic logbook and carried out these 4 tasks during a DVD recorded session. Recordings were anonymized and blindly assessed independently by five proctors. Inter-rater reliability was checked on a sample of five videos by the calculation of intra-class correlation coefficient. Task-specific clinical background of participants was correlated with their personal performance on the simulator. Breakpoint analysis was used to define the minimum number of performed cases, to be considered “proficient”. “Proficient” and “Non-proficient” groups were compared for construct validity assessment. Likert scale-based questionnaires were used to test content and to comment on when the EST-s1 exams should be undertaken within the residency program.


124 participants (105 final-year residents and 19 faculty members) took part in this study. The breakpoint analysis showed a significant change in performance curve at 36, 41, 67 and 206 s, respectively, corresponding to 30, 60, 25 and 120 clinical cases for each of the 4 tasks. EST-s1 was scored as a valid training tool, correctly representing the procedures performed in each task. Experts felt that this curriculum is best used during the third year of residency training.


Our validation study successfully demonstrated correlation between clinical expertise and EST-s1 tasks, adding construct validity evidence to it. Our work also demonstrates the successful collaboration established within various EAU sections.


Stone treatment Training EST-s1 Hands-on training Education Curriculum Training protocol 



European Association of Urology


Hands-on training


Young Academic Urologists


European Urology Residents Education Programme


Endoscopic stone treatment step 1 (curriculum)


European School of Urology


European Section of Uro-Technology


European Section of Urolithiasis




Standard deviation



ESU Training Group members are: Ben Van Cleynenbreugel, Domenico Veneziano, Ali Gozen, Bhaskar Somani. All their institutions are already in the paper as they are also listed as authors.

Author contributions

DV: project development, data Collection, and manuscript writing. AP: data collection. SP: data collection. TT: data collection. GK: data collection. GT: statistics. BVC: data collection. AG: data collection. AB: data collection. JP: data collection. KS: data collection. EL: data collection. KA: data collection. BKS: project development and manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Domenico Veneziano
    • 1
    • 2
    • 3
    • 4
    Email author
  • Achilles Ploumidis
    • 5
  • Silvia Proietti
    • 6
  • Theodoros Tokas
    • 7
  • Guido Kamphuis
    • 8
  • Giovanni Tripepi
    • 9
  • Ben Van Cleynenbreugel
    • 10
  • Ali Gozen
    • 11
  • Alberto Breda
    • 12
  • Joan Palou
    • 12
  • Kemal Sarica
    • 13
  • Evangelos Liatsikos
    • 14
  • Kamran Ahmed
    • 15
  • Bhaskar K. Somani
    • 16
  • ESU Training Group
  1. 1.Department of Urology and Kidney TransplantGOMReggio CalabriaItaly
  2. 2.Life and Health Sciences Research Institute (ICVS), School of MedicineUniversity of MinhoBragaPortugal
  3. 3.ICVS/3B’S, PT Government Associate LaboratoryBragaPortugal
  4. 4.Department of UrologyHofstra University School of MedicineNew YorkUSA
  5. 5.Athens Medical CenterAthensGreece
  6. 6.Department of UrologySan Raffaele Hospital, Ville Turro DivisionMilanItaly
  7. 7.Department of Urology and AndrologyGeneral Hospital Hall in TirolInnsbruckAustria
  8. 8.Academisch Medisch CentrumAmsterdamThe Netherlands
  9. 9.Centro Nazionale Ricerca IFC, U.O. of NephrologyReggio CalabriaItaly
  10. 10.Department of UrologyUniversity Hospital Gasthuisberg, Katholieke Universiteit LeuvenLeuvenBelgium
  11. 11.Department of Urology, Klinikum HeilbronnHeilbronnGermany
  12. 12.Department of UrologyFundació Puigvert, Universitat Autònoma de BarcelonaBarcelonaSpain
  13. 13.Department of UrologyDr. Lütfi Kǵrdar Kartal Research and Training HospitalIstanbulTurkey
  14. 14.Department of UrologyUniversity of PatrasPatrasGreece
  15. 15.Department of UrologyGuy’s HospitalLondonUK
  16. 16.Department of UrologyUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK

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