855 ASSESSING THE ACCURACY OF ENDOSCOPIC ESTIMATES OF LESION SIZE IN UROLOGY USING IN VITRO MODELS OF THE URINARY TRACT – DOES SIZE AND SKILL MATTER?

Abstract

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment/Ureteroscopy I1 Apr 2012855 ASSESSING THE ACCURACY OF ENDOSCOPIC ESTIMATES OF LESION SIZE IN UROLOGY USING IN VITRO MODELS OF THE URINARY TRACT – DOES SIZE AND SKILL MATTER? Peter Massaro, Mohamed Abdolell, and Richard Norman Peter MassaroPeter Massaro Halifax, Canada More articles by this author , Mohamed AbdolellMohamed Abdolell Halifax, Canada More articles by this author , and Richard NormanRichard Norman Halifax, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.948AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urologists frequently estimate the size of lesions with cystoscopy and ureteroscopy and alter their therapeutic approach based on these estimates. However, the accuracy of estimating lesion size using these modalities has not been established. The objectives of this study were to determine the accuracy of such estimates using in vitro models of the urinary tract and to identify whether it varied with the size and appearance of the lesion, level of urological training or use of a visual reference. METHODS Eleven staff and nine learners from the Department of Urology carried out rigid cystoscopy on a series of pig bladders containing papillary (ball bearings) and sessile (washers) lesions of various sizes. Each provided three sets of size estimates: two using only the cystoscope in order to assess intra-observer agreement and the third with the aid of a ureteric catheter as a visual reference. Similar estimates were then made with a flexible ureteroscope on a series of papillary lesions within an inorganic urinary tract model. Welch two-sample and paired t-tests were used to assess differences in mean estimates and the intraclass correlation coefficient (ICC) was used to assess the agreement between repeat estimates. RESULTS The level of endoscopic training did not significantly influence the mean error in estimation for either cystoscopy or ureteroscopy regardless of lesion size and appearance. Staff and learners consistently underestimated the size of observed lesions with median errors ranging from 6% to 49% for cystoscopy and from 37% to 56% for ureteroscopy (top graphs). Overall, participants demonstrated excellent (median ICC of 0.97) and fair (median ICC of 0.56) reproducibility of estimates with cystoscopy and ureteroscopy respectively (bottom graphs). For all lesions, use of the visual reference during cystoscopy did not significantly change the mean error of estimation. CONCLUSIONS Our results show that urologic endoscopists, regardless of their level of training, tend to substantially underestimate the size of observed lesions with both ureteroscopy and cystoscopy, despite fair to excellent reproducibility of their estimates respectively. This finding is independent of lesion size and appearance as well as the use of a visual reference during cystoscopy. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e349 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Massaro Halifax, Canada More articles by this author Mohamed Abdolell Halifax, Canada More articles by this author Richard Norman Halifax, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...