A newly developed porcine training model for transurethral piecemeal and en bloc resection of bladder tumour



The Asian Urological Surgery Training & Education Group (AUSTEG) has been established to provide training and education to young urologists in Asia. We developed and validated a porcine bladder training model for transurethral resection of bladder tumour (TURBT).


Urology residents and specialists were invited to test the training model. They were asked to complete a pre-task questionnaire, to perform piecemeal and en bloc resection of ‘bladder tumours’ within the training model, and to complete a post-task questionnaire afterwards. Their performances were assessed by faculty members of the AUSTEG. For the face validity, a pre-task questionnaire consisting of six statements on TURBT and the training model were set. For the content validity, a post-task questionnaire consisting of 14 items on the details of the training model were set. For the construct validity, a Global Rating Scale was used to assess the participants’ performances. The participants were stratified into two groups (junior surgeons and senior surgeons groups) according to their duration of urology training.


For the pre-task questionnaire, a mean score of ≥ 4.0 out of 5.0 was achieved in 5 out of 6 statements. For the post-task questionnaire, a mean score of ≥ 4.5 out of 5.0 was achieved in every item. For the Global Rating Scale, the senior surgeons group had higher scores than the junior surgeons group in 8 out of 11 items as well as the total score.


A porcine TURBT training model has been developed, and its face, content and construct validity has been established.

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Asian Urological Surgery Training & Education Group


Transurethral resection of bladder tumour


  1. 1.

    Herr HW, Donat SM (2008) Quality control in transurethral resection of bladder tumours. BJU Int 102(9 Pt B):1242–1246. https://doi.org/10.1111/j.1464-410x.2008.07966.x

    Article  PubMed  Google Scholar 

  2. 2.

    Mariappan P, Finney SM, Head E, Somani BK, Zachou A, Smith G, Mishriki SF, N’Dow J, Grigor KM, Edinburgh Urological Cancer G (2012) Good quality white-light transurethral resection of bladder tumours (GQ-WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non-muscle-invasive bladder cancer: validation across time and place and recommendation for benchmarking. BJU Int 109(11):1666–1673. https://doi.org/10.1111/j.1464-410X.2011.10571.x

    Article  PubMed  Google Scholar 

  3. 3.

    Mariappan P, Zachou A, Grigor KM, Edinburgh Urological Cancer G (2010) Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol 57(5):843–849. https://doi.org/10.1016/j.eururo.2009.05.047

    Article  PubMed  Google Scholar 

  4. 4.

    Kramer MW, Rassweiler JJ, Klein J, Martov A, Baykov N, Lusuardi L, Janetschek G, Hurle R, Wolters M, Abbas M, von Klot CA, Leitenberger A, Riedl M, Nagele U, Merseburger AS, Kuczyk MA, Babjuk M, Herrmann TR (2015) En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol 33(12):1937–1943. https://doi.org/10.1007/s00345-015-1568-6

    Article  PubMed  Google Scholar 

  5. 5.

    Kramer MW, Wolters M, Herrmann TR (2016) En bloc resection of bladder tumors: ready for prime time? Eur Urol 69(5):967–968. https://doi.org/10.1016/j.eururo.2016.01.004

    Article  PubMed  Google Scholar 

  6. 6.

    Babjuk M, Bohle A, Burger M, Capoun O, Cohen D, Comperat EM, Hernandez V, Kaasinen E, Palou J, Roupret M, van Rhijn BW, Shariat SF, Soukup V, Sylvester RJ, Zigeuner R (2017) EAU guidelines on non-muscle-invasive Urothelial Carcinoma of the Bladder: update 2016. Eur Urol 71(3):447–461. https://doi.org/10.1016/j.eururo.2016.05.041

    Article  Google Scholar 

  7. 7.

    Divrik RT, Sahin AF, Yildirim U, Altok M, Zorlu F (2010) Impact of routine second transurethral resection on the long-term outcome of patients with newly diagnosed pT1 urothelial carcinoma with respect to recurrence, progression rate, and disease-specific survival: a prospective randomised clinical trial. Eur Urol 58(2):185–190. https://doi.org/10.1016/j.eururo.2010.03.007

    Article  PubMed  Google Scholar 

  8. 8.

    Grimm MO, Steinhoff C, Simon X, Spiegelhalder P, Ackermann R, Vogeli TA (2003) Effect of routine repeat transurethral resection for superficial bladder cancer: a long-term observational study. J Urol 170(2 Pt 1):433–437. https://doi.org/10.1097/01.ju.0000070437.14275.e0

    Article  PubMed  Google Scholar 

  9. 9.

    Chen X, Liao J, Chen L, Qiu S, Mo C, Mao X, Yang Y, Zhou S, Chen J (2015) En bloc transurethral resection with 2-micron continuous-wave laser for primary non-muscle-invasive bladder cancer: a randomized controlled trial. World J Urol 33(7):989–995. https://doi.org/10.1007/s00345-014-1342-1

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Liu H, Wu J, Xue S, Zhang Q, Ruan Y, Sun X, Xia S (2013) Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 41(4):984–992. https://doi.org/10.1177/0300060513477001

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Naselli A, Puppo P (2017) En bloc transurethral resection of bladder tumors: a new standard? J Endourol 31(S1):S20–S24. https://doi.org/10.1089/end.2016.0534

    Article  PubMed  Google Scholar 

  12. 12.

    Teoh JYC, Herrmann TRW, Babjuk M et al (2018) Re: Valeria Panebianco, Yoshifumi Narumi, Ersan Altun, et al. Multiparametric Magnetic Resonance Imaging for Bladder Cancer: Development of VI-RADS (Vesical Imaging-Reporting And Data System). Eur Urol 74, 2018, 294–306. Eur Urol 74:294–306. https://doi.org/10.1016/j.eururo.2018.09.007

    Article  Google Scholar 

  13. 13.

    Gakis G, Karl A, Bertz S, Burger M, Fritsche HM, Hartmann A, Jokisch F, Kempkensteffen C, Miller K, Mundhenk J, Schneevoigt BS, Schubert T, Schwentner C, Wullich B, Stenzl A (2017) Transurethral en-bloc hydrodissection for non-muscle invasive bladder cancer: results of a randomized controlled trial. Eur Urol Suppl 16(3):1143–1144. https://doi.org/10.1016/s1569-9056(17)30713-3

    Article  Google Scholar 

  14. 14.

    Clarebrough E, Christidis D, Lindner U, Fernandes K, Fleshner N, Lawrentschuk N (2018) Analysis of a practical surgical skills laboratory for nerve sparing radical prostatectomy. World J Urol. https://doi.org/10.1007/s00345-018-2472-7

    Article  PubMed  Google Scholar 

  15. 15.

    Van Bruwaene S, Namdarian B, Challacombe B, Eddy B, Billiet I (2018) Introducing new technology safely into urological practice. World J Urol 36(4):543–548. https://doi.org/10.1007/s00345-018-2173-2

    Article  PubMed  Google Scholar 

  16. 16.

    Schout BM, Bemelmans BL, Martens EJ, Scherpbier AJ, Hendrikx AJ (2009) How useful and realistic is the uro trainer for training transurethral prostate and bladder tumor resection procedures? J Urol 181(3):1297–1303. https://doi.org/10.1016/j.juro.2008.10.169 (discussion 1303)

    Article  PubMed  Google Scholar 

  17. 17.

    Aydin A, Raison N, Khan MS, Dasgupta P, Ahmed K (2016) Simulation-based training and assessment in urological surgery. Nat Rev Urol 13(9):503–519. https://doi.org/10.1038/nrurol.2016.147

    Article  PubMed  Google Scholar 

  18. 18.

    de Vries AH, van Genugten HG, Hendrikx AJ, Koldewijn EL, Schout BM, Tjiam IM, van Merrienboer JJ, Muijtjens AM, Wagner C (2016) The Simbla TURBT simulator in urological residency training: from needs analysis to validation. J Endourol 30(5):580–587. https://doi.org/10.1089/end.2015.0723

    Article  PubMed  Google Scholar 

  19. 19.

    Shamim Khan M, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J, Ahmed M, Jaye P, Dasgupta P (2013) Development and implementation of centralized simulation training: evaluation of feasibility, acceptability and construct validity. BJU Int 111(3):518–523. https://doi.org/10.1111/j.1464-410X.2012.11204.x

    Article  PubMed  Google Scholar 

  20. 20.

    Schout B, Dolmans V, Bemelmans B, Schoot D, Scherpbier A, Hendrikx A (2008) Teaching diagnostic and therapeutic procedures of bladder pathology using a newly developed pig bladder model. J Endourol 22(11):2547–2553. https://doi.org/10.1089/end.2008.0316

    Article  PubMed  Google Scholar 

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JYCT: project development, data collection, data analysis, manuscript writing. CLC: project development, data collection, manuscript writing. YW: project development, data collection, manuscript writing. SI: data analysis, manuscript editing. HYT: data analysis, manuscript editing. TAO: data analysis, manuscript editing. KK: data collection, manuscript editing. PSKC: data collection, manuscript editing. ESYC: project development, data collection, manuscript editing. CFN: project development, data collection, manuscript editing.

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Correspondence to Jeremy Yuen-Chun Teoh or Chi-Fai Ng.

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Teoh, J.Y., Cho, C., Wei, Y. et al. A newly developed porcine training model for transurethral piecemeal and en bloc resection of bladder tumour. World J Urol 37, 1879–1887 (2019). https://doi.org/10.1007/s00345-018-2602-2

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  • Bladder cancer
  • Bladder tumour
  • Training model
  • Education
  • En bloc resection