Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course



To present the three-year experience of the multi-component TURP module at Urology Simulation Bootcamp Course (USBC) and demonstrate trainee’s competence progression and satisfaction.


During the USBC, a 4-h TURP module was developed and consisted of (a) familiarisation and assembly of resectoscope instrument, (b) didactic lecture on TURP operative techniques and postoperative complications, (c) learning hands-on resection on validated simulators [Samed, GmBH, Dresden, Germany; TURP Mentor™, Simbionix, Israel], and (d) practicing clot evacuation using the Ellik bladder Evacuator. Trainee’s level of instrument knowledge, operative competence, and confidence were assessed pre- and post-course. Trainee’s feedback was also collected.


One hundred thirty trainees participated in the USBC between 2016 and 2018. Eighty-seven percent of trainees scored themselves as 1–3 (low confidence in resection) on a 5-point Likert scale. Trainees significantly improved in their ability to perform resectoscope assembly for resection, coagulation and incision by 33.6% (p < 0.001), 28.1% (p < 0.001) and 34.0% (p < 0.001), respectively. There was a significant improvement in scores in itemised technical skill on the TURP simulator following completion of the TURP module (Mean difference = 3.4 points, 95% CI 2–4, p < 0.001). Ninety-one percent of trainees agreed that the TURP module was useful for their development in urological training.


Our results demonstrated that it is feasible to develop and implement a focussed module for teaching TURP with significant improvement in learning. Trainee feedback suggests that they were highly satisfied with the teaching provided and models used. This style of training can be implemented for other common surgical procedures.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Young MJ, Elmussareh M, Morrison T, Wilson JR (2018) The changing practice of transurethral resection of the prostate. Ann R Coll Surg Engl 100(4):326–329

    CAS  Article  Google Scholar 

  2. 2.

    Malaeb BS, Yu X, McBean AM, Elliott SP (2012) National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000–2008). Urology 79(5):1111–1116

    Article  Google Scholar 

  3. 3.

    Chung ASJ, Woo HH (2018) Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol 5(1):22–27

    Article  Google Scholar 

  4. 4.

    Bjerrum F, Thomsen ASS, Nayahangan LJ, Konge L (2018) Surgical simulation: current practices and future perspectives for technical skills training. Med Teach 40(7):668–675

    Article  Google Scholar 

  5. 5.

    Ramirez AG, Hu Y, Kim H, Rasmussen SK (2018) Long-term skills retention following a randomized prospective trial on adaptive procedural training. J Surg Educ 75(6):1589–1597

    Article  Google Scholar 

  6. 6.

    de Vries AH, Schout BM, van Merrienboer JJ, Pelger RC, Koldewijn EL, Muijtjens AM et al (2017) High educational impact of a national simulation-based urological curriculum including technical and non-technical skills. Surg Endosc 31(2):928–936

    Article  Google Scholar 

  7. 7.

    Tjiam IM, Berkers CH, Schout BM, Brinkman WM, Witjes JA, Scherpbier AJ et al (2014) Evaluation of the educational value of a virtual reality TURP simulator according to a curriculum-based approach. Simul Healthc 9(5):288–294

    Article  Google Scholar 

  8. 8.

    Biyani CS, Hanchanale V, Rajpal S, Jain S, Garthwaite M, Cartledge J et al (2017) First urology simulation boot camp in the United Kingdom. Afr J Urol 23(3):258–267

    Article  Google Scholar 

  9. 9.

    Kailavasan M, Hanchanale V, Rajpal S, Morley R, McLlhenny C, Somani B et al (2019) A method to evaluate trainee progression during simulation training at the urology simulation boot camp (USBC) course. J Surg Educ 76(1):215–222

    Article  Google Scholar 

  10. 10.

    Young M, Kailavasan M, Taylor J, Cornford P, Colquhoun A, Rochester M et al (2019) The success and evolution of a urological "boot camp" for newly appointed UK urology registrars: incorporating simulation, nontechnical Skills and Assessment. J Surg Educ 76:1425–1432

    CAS  Article  Google Scholar 

  11. 11.

    Programme ISC (2016) Intercollegiate surgical cirriculum for urology surgery

  12. 12.

    Wiggins GMJ (2001) Undestanding by design: Upper Saddle River

  13. 13.

    Zevin B, Levy JS, Satava RM, Grantcharov TP (2012) A consensus-based framework for design, validation, and implementation of simulation-based training curricula in surgery. J Am Coll Surg. 215(4):580–586

    Article  Google Scholar 

  14. 14.

    Marszalek M, Ponholzer A, Pusman M, Berger I, Madersbacher S (2009) Transurethral resection of the prostate. Eur Urol Suppl 8:504–512

    Article  Google Scholar 

  15. 15.

    Gravenstein D (1997) Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth Analg 84:438–446

    CAS  Article  Google Scholar 

  16. 16.

    Bright E, Vine S, Wilson MR, Masters RS, McGrath JS (2012) Face validity, construct validity and training benefits of a virtual reality TURP simulator. Int J Surg 10(3):163–166

    Article  Google Scholar 

  17. 17.

    Kishore TA, Beddingfield R, Holden T, Shen Y, Reihsen T, Sweet RM (2009) Task deconstruction facilitates acquisition of transurethral resection of prostate skills on a virtual reality trainer. J Endourol 23(4):665–668

    Article  Google Scholar 

  18. 18.

    Ebbing J, Schostak M, Steiner U, Stier K, Neymeyer J, Miller K et al (2011) Novel low-cost prostate resection trainer-description and preliminary evaluation. Int J Med Robot 7(3):367–373

    Article  Google Scholar 

  19. 19.

    Vassiliou MC, Kaneva PA, Poulose BK, Dunkin BJ, Marks JM, Sadik R et al (2010) Global Assessment of Gastrointestinal Endoscopic Skills (GAGES): a valid measurement tool for technical skills in flexible endoscopy. Surg Endosc 24(8):1834–1841

    Article  Google Scholar 

  20. 20.

    Khan R, Aydin A, Khan MS, Dasgupta P, Ahmed K (2015) Simulation-based training for prostate surgery. BJU Int 116(4):665–674

    Article  Google Scholar 

  21. 21.

    Hanchanale V, Kailavasan M, Rajpal S, Koenig P, Yiasemidou M, Palit P, Rogawski K, Eardley I, Terry T, Jain S, Myatt M, Biyani CS (2019) Impact of urology simulation boot camp in improving endoscopic instrument knowledge. BMJ Simul Technol Enhanced Learn.

    Article  Google Scholar 

  22. 22.

    Neumann E, Mayer J, Russo GI, Amend B, Rausch S, Deininger S et al (2018) Transurethral resection of bladder tumors: next-generation virtual reality training for surgeons. Eur Urol Focus. 5:906–911

    Article  Google Scholar 

  23. 23.

    Viswaroop SB, Gopalakrishnan G, Kandasami SV (2015) Role of transurethral resection of the prostate simulators for training in transurethral surgery. Curr Opin Urol 25(2):153–157

    Article  Google Scholar 

Download references


We would like to thank all participants and module co-faculty for their continued support: Safraz Ahmad, James Armitage, Andreas Bourdoumis, Nick Campain, Ivo Dukic, Ismail E-Mokadem, Paul Halliday, Adrian Joyce, Phil Koenig, Sanjay Rajpal, Karol Rogawski, Tariq Tassadaq, Petros Tsafrakidis, Ross Vint. We could not have done without the excellent support from Joanne Johnson, Jodie Fowler Lesley Wood, MarK Logan, Jack Holmes and Dave Gould Medical Education Team, Leeds Teaching Hospital, Leeds.


Equipment and sponsorship for the Urology Simulation Boot Camp were provided by: Karl Storz, Cook Medical, Coloplast, Ethicon, Dantec, OKB Medical (Simbionix), MediPlus, Teleflex, European Pharma.

Author information




Protocol/project development: CSB, GN. Data collection or management: MK, CB, GA, AG, BR, SJ. Data analysis: MK, CB. Manuscript writing/editing: MK, CB, CSB, GN.

Corresponding author

Correspondence to Chandra S. Biyani.

Ethics declarations

Conflict of interest


Research involving Human Participants and/or Animals

Not applicable.

Informed consent

All participants in this study provided written informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kailavasan, M., Berridge, C., Athanasiadis, G. et al. Design, implementation, and evaluation of a novel curriculum to teach transurethral resection of the prostate (TURP): a 3-year experience of urology simulation bootcamp course. World J Urol 38, 2899–2906 (2020).

Download citation


  • Simulation
  • Transurethral resection of prostate
  • Surgical skills
  • Surgical education