International Expert Consensus on Development of a State of the Art Male Perineal Anatomy Simulation Model for Urethroplasty and Artificial Urinary Sphincter Insertion

Objective: To create a high-fidelity, non-biohazardous, simulation model to train for urethroplasty or placement of artificial urinary sphincters (AUS) in the bulbar urethra. Narrow, deep and dark: the male perineum is a technically difficult area for learners to gain surgical skills and confidence. Methods: Nineteen high volume reconstructive urologists were recruited to complete a Delphi process to reach an expert consensus on parameters and design specifications for simulation. Consensus (>80%) was reached regarding procedural realism, anatomical realism, and educational effectiveness. Using validated 3D printing and hydrogel molding techniques, we fabricated a model incorporating expert determined aspects. Prototypes were sent to 11 (58%) of the experts who performed skin-to-skin AUS and urethroplasty simulations. Autopsy and questionnaires evaluated the model to determine if the consensus-defined deliverables were met, and confirm the realism of anatomy during the procedures. Results: Overall, experts agreed the model could function as a training tool for urethral surgery. 91%, 82%, and 100% agreed the model procedurally replicates the steps necessary to complete urethral exposure, tissue textures/behaviors, and overall anatomical relationships, respectively. Experts agreed on the fidelity of perineal incision/exposure (91%), urethral dissection/exposure (100%), placement of AUS pump (89%) urethral cuff measurement (100%) urethral spatulation (91%), and urethral mucosal suture placement (91%). Conclusion: We successfully designed a high-fidelity, non-biohazardous, simulation model for urethral procedures in the perineum utilizing expert consensus. The model displayed high procedural and anatomical realism, and has potential as an effective educational platform. This as a groundbreaking tool to enhance training in complex urethral surgeries, bridging the gap between theory and practice.