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Urology needs models of competencies assessment, although there is a wide range of tools not yet integrated into the official training programs., Context: At present, there is no universal framework for measuring surgeons' level of competence. Urology training programs should provide and consider knowledge, pyschomotor/cognitive skills, and simulator, cadaver or animal models-based training. Validity is a complex concept that refers to the capacity of the evaluation tool, so it is necessary to demonstrate several types of validation to assure the capacity of a method, reinforced with different reliability tests and calculation of internal consistency between evaluators., Objective: Based on a structured dossier of surgical skills, classified by groups, the ESSCOLAP® Basic system was proposed with 5 simulator tasks to evaluate basic laparoscopic skills. Once validated in the JUMISC (Spain), the tool was proposed to extend its scope and implementation in other locations., Results: Our system has not yet demonstrated a full validity in the real clinical setting because a predictive validity needs to be demonstrated on the basis of clinical data. It also suffers from a certain range of subjectivity, thus implying clear and defined criteria for any situation. Factors like the number of evaluators and tasks to assess will influence the reliability tests that measure the degree of agreement between evaluators, so that a higher number of evaluated cases would imply a greater reliability of our system. Finally, we assume that the incorporation of this type of tools implies an added cost, charged to the public and private responsible institutions, which will only be considered cost-effective when it is demonstrated its real and positive traceability in health outcomes., Conclusions: ESSCOLAP® Basic, of quick and simple implementation capacity, has been validated and calibrated for the evaluation of basic technical skills in laparoscopy.

The lack of globally established standards for learning urological laparoscopy has not prevented laparoscopic techniques from evolution and continuous development. Laparoscopy coexists with robotic surgery today, and in the last decade there have been many techniques that have undergone a boom with the use of a laparoscopic approach (total and partial nephrectomy, pyeloplasty, colposacropexy, etc.).We intend to evaluate the progressive incorporation of different surgical techniques in the laparoscopic learning program and, on the other hand, to analyze the evolution of training programs in urological laparoscopy to bring this type of techniques within the hospital surgical activity. We describe our 30-years experience in different training programs in urological laparoscopy that have been sponsored by the Spanish Association of Urology (AEU), and have undergone several validity studies to assess their capacity in order to evaluate effectively basic and advanced laparoscopic skills. We will also highlight the current and future trend towards training models based on surgical competences where individualized training, accreditation and specialization of tutors is crucial, and where the increase in the use of training and evaluation methods based on the simulation are increasingly common.

Objectives: We aim to analyse the role of new technologies in management of small renal cancer., Methods: We perform a non-systematic review of the literature in Medline, Cochrane Database of Systematic Reviews between period 2000-2012, using following mesh terms: partial nephrectomy, renal ablative technologies, and renal cancer., Results: We don't review in this article ablative technologies such as cryotherapy, radiofrequency, as they are the subject of others manuscripts within this monographic issue. We focus on high intensity ultrasounds (HIFU) microwaves therapy, radiosurgery, laser and water jet dissection., Conclusions: New technologies in partial nephrectomy are under constant and vertiginous evolution. Although efficacy has been demonstrated in short term and isolated studies, more studies, better designed, with bigger sample size and longer follow up are needed.

Objectives: To evaluate the rate of secondary or complicated vesicoureteral reflux (VUR) among the total number of VUR cases treated in our institution. To determine the efficacy of the endoscopic treatment in secondary or complicated VUR depending on etiology and grade., Method: We review our experience with endoscopic treatment for VUR from 1992 to 2006. We have used three different materials: polytetrafluoroethylen (Teflon), polydimethyls iloxane (Macroplastique) and dextranomer/hyaluronic acid copolymer (Deflux). 479 ureters with VUR were treated in 402 patients; 124 patients and 142 ureters of them were secondary or complicated VUR cases. All patients were followed up with urinary tract ultrasound and radiological or isotopic voiding cystogram. Success is defined as VUR disappearance or improvement to grade I VUR without urinary infection after removing antibiotic prophylaxis., Results: The success rate has been 71.13% after the first injection, 85.92% after the second injection and 90.14% after the third injection. Mean subureteral dose has been 0.65 ml. The complications rate has been 0%., Conclusions: The endoscopic treatment in secondary or complicated VUR is a minimally invasive procedure. It seems to be more difficult than in primary VUR cases, but its low morbidity and efficacy indicate this may be a proper first option in selected patients. In cases of VUR secondary to neurogenic bladder dysfunction it seems to be less successful, probably because of a worse control of the high bladder pressure.