467the detrusor muscle, usually via 20–30, 1 cc injections [ 106 ]. There is currently only
one VR trainer in the literature, which was developed at the University of Minnesota.
Their system provides virtual bladder models of multiple sizes and bladder wall
thickness, which allows learning of variable injection patterns with optimum pene-
tration depth and dose control [ 106 ]. However, this simulator is currently not com-
mercially available and is yet to be formally verified. Nonetheless, it presents a
potential source of simulation for an increasingly more performed procedure.
Prostate
Transurethral Resection of the Prostate (TURP)
Transurethral resection of the prostate (TURP) is the classic, gold-standard proce-
dure for the treatment of medically refractory lower urinary tract symptoms second-
ary to benign prostatic hyperplasia (BPH). However, as pointed out by Wignall
et al., the learning curve to properly perform TURP is steep for several reasons.
Users must work in a small three-dimensional space represented on a two-
dimensional monitor, which requires substantial visual-spatial coordination [ 107 ].
This procedure is made more difficult as it is very common to experience intraop-
erative visual impairment from tissue and blood. Furthermore, serious adverse
events can occur from this procedure, including urinary incontinence, erectile dys-
function, profuse bleeding, hyponatremia, and injury to a number of key structures
including the urethra, ureter, or rectum [ 107 ]. Once a popular procedure is per-
formed during residency, there has been a halving in the number of TURPs done by
graduating urology residents over the last 15–20 years [ 107 , 108 ]. Therefore, there
is a demand for TURP simulators to help augment the learning of this procedure.
abcd e fFig. 24.10 Partial nephrectomy model proposed by Hung et al., (a) equipment used in model, (b)
melon scooper used to score renal capsule, (c) a 15-blade scalpel is used to create a defect, (d)
superglue applied to defect, (e) foam ball affixed to model, (f) excision of foam tumor [ 79 ]
24 Simulation in Surgery