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Updated: Jan 8, 2026
Ultrasonography of the Adult Male Urinary Tract for Urinary Functional Testing
Published on: August 14, 2019
Intraoperative Skills for Transurethral Resection of Bladder Tumor: Objective Assessment and Construct Validity of
Pietro Diana1, Marco Paciotti2, Nicola Frego3
1Department of Urology, Fundació Puigvert, Barcelona, Spain; Department of Surgery, Autonomous University of Barcelona, Bellaterra, Spain.
Background And Objective:
Transurethral resection of bladder tumor (TURBT) is one of the procedures most often performed by trainee urologists. ENTRY is a cooperative partnership aimed at improving the training of urology residents. Metrics for TURBT were published after a Delphi consensus process involving experts. The aim of this study was to assess the reliability and construct validity (via known-group and convergent validity) of objective metrics for characterizing the intraoperative performance of TUTBT as optimal versus suboptimal.
Methods:
Thirty videos of TURBT performed by experts (n = 15) and novices (n = 15) were evaluated by three experienced urologists trained to reliably and independently score TURBT performance using the metrics previously developed. The videos were anonymized and the assessors were blinded to the surgeon, hospital, and expertise. The inter-rater reliability score was assessed and surgical errors were reported using a dummy dichotomous variable. A two-sample Wilcoxon rank-sum (Mann-Whitney) test was applied for between-group comparisons.
Key Findings And Limitations:
The median number of overall errors was 1 (interquartile range [IQR] 0-2) in the expert group versus 5 (IQR 4-7) in the novice group, with a median difference of -4 errors (95% confidence interval [CI] -5 to -3; p = 0.001). The median number of noncritical errors per TURBT procedure was 1 (IQR 0-2) in the expert group versus 3 (IQR 2-4) in the novice group, with a median difference of -2 errors (95% CI -3 to -1; p = 0.001). The median number of critical errors was 0 (IQR 0-1) for the expert group versus 2 (IQR 2-3) for the novice group, with a median difference of -2 errors (95% CI -3 to -1; p = 0.001). We compared the performance of the expert and novice groups, which revealed a concordance index of 0.6 for noncritical errors, 0.73 for critical errors, and 0.66 for overall errors.
Conclusions And Clinical Implications:
Our study demonstrates the construct validity of metrics developed for the quality of TURBT performance. This represents a further step in establishing a quality-assured structured and standardized training program for TURBT.
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