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

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Background and objective 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. Methods 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). Key findings and limitations 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%). Conclusions and clinical implications 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. Patient summary 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.

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