Face and content validation of laser enucleation of prostate simulation model: an EAU European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group study.

Abstract

INTRODUCTION: Laser enucleation of the prostate (LEP) has become a standard treatment for benign prostatic obstruction, yet its adoption is limited by a steep learning curve and a lack of validated training models. This study aimed to evaluate the face and content validity of a bench-top simulator specifically developed for LEP training within the framework of the European School of Urology (ESU) Lower Urinary Tract Endoscopy Working Group.

METHODS: Fourteen expert endourologists assessed the simulator during the European Urology Residents Education Programme (EUREP) 2025. Face and content validity were evaluated using 4-point Likert questionnaires, structured using the ESU validation framework. Descriptive statistics and content validity indices (I-CVI, S-CVI/Ave, S-CVI/UA) were calculated to assess agreement across anatomical, procedural, and educational domains.

RESULTS: Face validity scores were high across all items (mean 3.57-3.86; >=90% agreement). The overall S-CVI/Ave was 0.85 and S-CVI/UA 0.47. Domain-specific analysis showed strong content validity for procedural steps (S-CVI/Ave = 0.89) and educational/global domains (0.95), moderate validity for essential anatomy (0.81), and lower ratings for intraoperative conditions (0.69), primarily due to the absence of bleeding simulation. When restricted to core domains (procedural + educational), S-CVI/Ave improved to 0.91.

CONCLUSION: The simulator demonstrated strong face and content validity. Expert ratings indicated favorable perceptions of its realism, procedural similarity, and educational utility. These findings suggest that the simulator may be a useful component of a structured transurethral procedural training curriculum, although further construct validation is needed.