How to teach the teacher to teach the TUR-B.

OBJECTIVES

We report on our training program in teaching TUR of bladder tumours to seven trainees in two distinct periods. We analysed their problems and those from teachers and we present our solutions.

MATERIAL AND METHODS

Between April 2000 and April 2004 seven trainees performed 842 TUR of bladder tumours. In a prospective study we assessed intraoperative and immediate postoperative complications of the procedures and analysed their causes.

RESULTS

In 48 months 842 teaching TUR were performed. Six hundred and thirty-one patients (75%) were male and 211 (25%) were female. The average age was 63.4 years (range 32-92) in the males and 67.3 years (range 48-91) in the females. There were complications in 81 cases (6.1%). The most common complication was bleeding. It occurred in 47 cases (3.5%). The second most common complication was bladder perforation. It occurred in 18 cases (1.3%). All but one of the patients who experienced a bladder perforation were male and all but one of the perforations were extraperitoneal and could be managed in a conservative fashion.

CONCLUSION

The standard of TUR is video-controlled resection. The procedure has to be standardised following a protocol to avoid incomplete resections. The trainee should start his TUR experience on middle sized prostates and once the first skills have been acquired he can start to resect bladder tumours in so called "safe areas". The last step is then complete autonomy. To bring a trainee to this goal remains a challenge for each trainer.