Utility of a novel and cost-effective biological model for percutaneous renal access training

Nephrolithiasis is a highly prevalent and recurrent disease in urology. Currently, percutaneous nephrolithotomy (PNL) is recommended when treating a kidney stone larger than 2 cm according to the American Urological Association (AUA) and European Association of Urology (EAU) Guidelines. The utmost crucial part of PNL is to obtain the percutaneous renal access (PRA). Thus, for urologist without PNL experience, it is important to practice obtaining PRA in a controlled environment. The aim of this study is to develop and evaluate a model for PRA training under ultrasonic guidance.

This was a prospective experimental study that was conducted from September to November 2023. The biological model was made of porcine kidneys with ureters embedded in carrageenan gel. Ultrasound guidance was utilized for PRA. Ten experts in PNL and 30 urology residents with no relevant experience novices were enrolled in the study. Novices underwent a pre-training and post-training assessment, the latter occurring after one hour of training. Recorded data included total puncture time, ultrasound screening time, and the number of puncture attempts. Experts were requested to evaluate the model through a questionnaire.

Comparisons of 30 novices' pre- and post-training results indicated significant skill acquisition, with shorter total procedure time, reduced ultrasound screening time, and fewer attempts for successful puncture (all P<0.001). All 10 experts completed the questionnaire, and most rated the model as above average or excellent across four categories.

This biological model is simple, portable, and cost-effective, and is proven to be an effective training tool for PRA. It provides clear ultrasound image and could be widely used in training centers for novices.