Intravesical Injection of Bulking Agents: Validation of the Ghent University Hospital Porcine Teaching Model

Intravesical injection of bulking agents is an endoscopic treatment for vesicoureteral reflux (VUR) in children. The success of the procedure depends on the surgical technique; yet, few validated simulators exist for training. This study aimed to assess the face and content validity of a porcine bladder model for training in endoscopic VUR correction.

The Ghent University Hospital endoscopic reflux correction simulator, an ex vivo porcine bladder, was developed. Dextranomer/hyaluronic acid (Dx/HA) was used for bilateral subureteric injection. Participants from the 2022 European Society for Paediatric Urology Congress in Belgium completed a questionnaire evaluating the model's realism (face validity) and training effectiveness (content validity). Differences between experts and nonexperts were analyzed using the Mann-Whitney U test (p ≤ 0.05).

A total of 39 participants (12 experts and 27 nonexperts) evaluated the model, including urologists (53.8%), surgical trainees (35.9%), and pediatric surgeons (12.8%). The simulator showed high face validity, with a median Likert score of 5/5. The experts rated the realism significantly higher than the nonexperts (p = 0.011). The experts also rated content validity highly (median Likert score 5/5). Both groups agreed that the model should be included in training curricula for residents (92.3%), fellows (82%), and novice surgeons (59%).

The Ghent University Hospital porcine bladder model closely mimics a human bladder and is considered valuable for teaching the Dx/HA procedure. Further studies should examine whether this leads to clinically meaningful improvements in skill performance.

A high fidelity simulator is developed and validated in this study to improve surgical skills in endoscopic correction of vesicoureteral reflux, thereby improving patient outcomes.