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Chahal B, Aydin A, Ahmed K. Virtual reality vs. physical models in surgical skills training. An update of the evidence. Curr Opin Urol 2024; 34:32-36. [PMID: 37962178 PMCID: PMC10715699 DOI: 10.1097/mou.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
PURPOSE OF REVIEW Simulation is a key component of surgical training, enabling trainees to develop their skills in a safe environment. With simulators broadly grouped into physical models and virtual-reality (VR) simulators, it is important to evaluate the comparative effectiveness of the simulator types in terms of validity as well as cost. The review aims to compare the benefits and drawbacks of novel VR and physical simulators within the broader themes of endourology, laparoscopic and robotic operations, and other urological procedures. RECENT FINDINGS Key benefits of bench models include their comparatively lower cost, easy access and provision of haptic feedback, whereas VR simulators are generally self-sufficient, reusable and enable skills of haemostasis to be practised. The advent of perfused 3D printed simulators across a range of urological procedures may replace cadavers as the traditional gold-standard simulation modality. SUMMARY Although possessing differing strengths and downsides, VR and physical simulators when used together can have an additive effect due to skill transferability across the platforms. Further comparative studies are required to directly quantify the differences between physical models and VR simulators in terms of performance metrics and cost-effectiveness. There is lack of validated VR simulators for open and reconstructive procedures.
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Affiliation(s)
- Baldev Chahal
- MRC Centre for Transplantation, Guy's Hospital, King's College London
| | - Abdullatif Aydin
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Department of Urology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital, King's College London
- Khalifa University
- Department of Urology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Han DS, Ingram JW, Gorroochurn P, Badalato GM, Anderson CB, Joice GA, Simhan J. The State of Urotrauma Education Among Residency Programs in the United States: A Systematic Review and Meta-Analysis. Curr Urol Rep 2023; 24:503-513. [PMID: 37572174 DOI: 10.1007/s11934-023-01179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE OF REVIEW Management of urotrauma is a crucial part of a urologist's knowledge and training. We therefore sought to understand the state of urotrauma education in the United States. RECENT FINDINGS Using themes of "Urotrauma" and "Education," we performed a systematic review and meta-analysis by searching for studies in MEDLINE, all Cochrane libraries, EMBASE, BIOSIS, Scopus, and Web of Science through May 2023. The primary outcome was the pooled rate of urology trainee and program director attitudes toward urotrauma education. Secondary outcomes involved a descriptive summary of existing urotrauma curricula and an assessment of factors affecting urotrauma exposure. Of 12,230 unique records, 11 studies met the final eligibility criteria, and we included 2 in the meta-analysis. The majority of trainees and program directors reported having level 1 trauma center rotations (range 88-89%) and considered urotrauma exposure as an important aspect of residency education (83%, 95% CI 76-88%). Despite possible increases in trainee exposure to Society of Genitourinary Reconstructive Surgeons (GURS) faculty over the preceding decade, nearly a third of trainees and program directors currently felt there remained inadequate exposure to urotrauma during training (32%, 95% CI 19-46%). Factors affecting urotrauma education include the limited exposure to GURS-trained faculty and clinical factors such as case infrequency and non-operative trauma management. Urology resident exposure to urotrauma is inadequate in many training programs, underscoring the potential value of developing a standardized curriculum to improve urotrauma education for trainees. Further investigation is needed to characterize this issue and to understand how it impacts trainee practice readiness.
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Affiliation(s)
- David S Han
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, NY, 10032, New York, USA.
| | - Justin W Ingram
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, NY, 10032, New York, USA
| | | | - Gina M Badalato
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, NY, 10032, New York, USA
| | - Christopher B Anderson
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, NY, 10032, New York, USA
| | - Gregory A Joice
- Department of Urology, Columbia University Irving Medical Center, 161 Fort Washington Avenue, 11th Floor, NY, 10032, New York, USA
| | - Jay Simhan
- Department of Urology, Temple University Health System and Fox Chase Cancer Center, Philadelphia, PA, USA
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Nedbal C, Jahrreiss V, Cerrato C, Pietropaolo A, Galosi A, Veneziano D, Kallidonis P, Somani BK. Role of simulation in kidney stone disease: A systematic review of literature trends in the 26 years. World J Nephrol 2023; 12:104-111. [PMID: 37766839 PMCID: PMC10520753 DOI: 10.5527/wjn.v12.i4.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Minimally invasive techniques for treatment of urinary stones requires expertise, experience and endoscopic skills. Simulators provide a low-stress and low-risk environment while providing a realistic set-up and training opportunities. AIM To report the publication trend of 'simulation in urolithiasis' over the last 26 years. METHODS Research of all published papers on "Simulation in Urolithiasis" was performed through PubMed database over the last 26 years, from January 1997 to December 2022. Papers were labelled and divided in three subgroups: (1) Training papers; (2) Clinical simulation application or surgical procedures; and (3) Diagnostic radiology simulation. Each subgroup was then divided into two 13-year time periods to compare and identify the contrast of different decades: period-1 (1997-2009) and period-2 (2010-2022). RESULTS A total of 168 articles published on the application of simulation in urolithiasis over the last 26 years (training: n = 94, surgical procedures: n = 66, and radiology: n = 8). The overall number of papers published in simulation in urolithiasis was 35 in Period-1 and 129 in Period-2, an increase of +269% (P = 0.0002). Each subgroup shows a growing trend of publications from Period-1 to Period-2: training papers +279% (P = 0.001), surgical simulations +264% (P = 0.0180) and radiological simulations +200% (P = 0.2105). CONCLUSION In the last decades there has been a step up of papers regarding training protocols with the aid of various simulation devices, with simulators now a part of training programs. With the development of 3D-printed and high-fidelity models, simulation for surgical procedure planning and patients counseling is also a growing field and this trend will continue to rise in the next few years.
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Affiliation(s)
- Carlotta Nedbal
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Victoria Jahrreiss
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Clara Cerrato
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
| | - Andrea Galosi
- Department of Urology, Azienda Ospedaliero-Universitaria delle Marche, Polytechnic University of Marche, Ancona 60121, Italy
| | - Domenico Veneziano
- Department of Urology, The Smith Institute for Urology, Northwell Health, New York, NY 11042, United States
| | | | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, United Kingdom
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Ong K, Bald P, Dryhurst D, Ahmed S, Yusuf GT, Lunawat R, Sriprasad S, Thapa G, Tirnoveanu A, Webb R, Rahman E. The design and validation of a low-cost trans perineal (TP) prostate biopsy simulator for training: improving trainees' confidence and cognitive targeting skills. World J Urol 2023:10.1007/s00345-023-04387-y. [PMID: 37129680 PMCID: PMC10153043 DOI: 10.1007/s00345-023-04387-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
PURPOSE The aim of this research was to create a novel and low-cost TP prostate biopsy simulator that has face, content and construct validity with high educational value. METHODS This research developed a trans perineal prostate (TP) biopsy simulator using 3D-printed moulds and tissue-mimicking materials. Important regions (anterior, mid, and posterior zones) were coded with different colours. Ultrasound visible abnormal lesions were embedded in the prostate phantom. Expert and novice participants in TP biopsies were recruited. Essential skills were identified through the consensus of six experts. These skills were assessed through tasks performed by participants. This included the accuracy and timing of systematic and target biopsies. Immediate feedback was determined by the colour of the biopsy cores taken. A survey was distributed to evaluate its realism and educational value. RESULTS The material cost of one simulator was £7.50. This simulator was proven to have face, content, and construct validity. There was a significant difference (p = 0.02) in the accuracy of systematic biopsies between both experts and novices. Significant difference was also observed (p = 0.01), in accurately identifying target lesion on ultrasound between both groups. Participants rated the overall realism of the simulator 4.57/5 (range 3-5). 100% of the experts agreed that introducing this simulator to training will be beneficial. 85.7% of the participants strongly agree that the simulator improved their confidence in TP biopsies. CONCLUSION There is value in integrating this proof-of-concept TP prostate biopsy simulator into training. It has highly rated educational value and has face, content, and construct validity.
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Affiliation(s)
- Kelly Ong
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
- Princess Royal University Hospital, Farnborough Common, Bromley, Kent, BR6 8ND, UK
| | - Philip Bald
- Institute of Mechanical Engineers (IMechE), London, UK
| | - David Dryhurst
- Princess Royal University Hospital, Farnborough Common, Bromley, Kent, BR6 8ND, UK
| | - Saif Ahmed
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Gibran Tim Yusuf
- Princess Royal University Hospital, Farnborough Common, Bromley, Kent, BR6 8ND, UK
| | - Rahul Lunawat
- Princess Royal University Hospital, Farnborough Common, Bromley, Kent, BR6 8ND, UK
| | - Seshadri Sriprasad
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Gauri Thapa
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Alice Tirnoveanu
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Richard Webb
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK
| | - Eqram Rahman
- Institute of Medical Sciences, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Rowan Williams Court, 30 Pembroke Court, Chatham Maritime, Kent, ME4 4UF, UK.
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Orecchia L, Ricci M, Ippoliti S, Asimakopoulos AD, Rosato E, Fasano A, Manfrin D, Germani S, Finazzi Agrò E, Nardi A, Miano R. External Validation of the "Tor Vergata" 3D Printed Models of the Upper Urinary Tract and Stones for High Fidelity Simulation of Retrograde Intrarenal Surgery. J Endourol 2023; 37:607-614. [PMID: 36924301 DOI: 10.1089/end.2022.0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Novel training modalities are being investigated to overcome the challenges associated with learning Retrograde IntraRenal Surgery (RIRS). Consequently, a series of 3D printed models of the upper urinary tract and stones designed for ex-vivo surgical simulation was introduced in 2021. This study aims to provide external validation of the training model and assess its role in the development of surgical skills. MATERIALS AND METHODS A mixed cohort of 20 urologists at different levels of expertise participated in a whole-day live simulation event to examine the model and perform a timed simulation of intrarenal navigation, stone relocation and laser fragmentation. Operative times were recorded and two independent expert endourologists scored the simulations according to a modified Objective Structured Assessment of Technical Skills" (OSATS) scale. Five novice urologists from the cohort performed three further simulations in a subsequent event to assess improvement in surgical skills. RESULTS Face validity was demonstrated with a median score of ≥ 4/5 in in each of the 11 items investigated. Content validity was also successfully reached, with 100% positive impressions with regard to the usefulness for the acquisition of surgical skills. Significant differences were observed among operative times stratified per surgeon experience (all p < 0.0050), thus providing construct validity. Median total OSATS score for novices was 14 (range 8,25) and was found to be significantly different from expected expert performance (p = 0.0010). Repeated simulations by novices led to a progressive reduction of operative times (p=0.0313) and increase in median total OSATS (p =0.0625). CONCLUSION The 3D printed models of upper urinary tract and synthetic training stones for the high-fidelity simulation of each phase of RIRS were validate by this study. The results encourage the usage of the models in simulation courses and the evaluation of their potential role in standardised training curricula.
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Affiliation(s)
- Luca Orecchia
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Via Montpellier 1, Roma, Italy, 00133;
| | - Matteo Ricci
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | - Simona Ippoliti
- Hull University Teaching Hospitals NHS Trust, 4020, Urology, Hull, Kingston upon Hull, United Kingdom of Great Britain and Northern Ireland;
| | - Anastasios D Asimakopoulos
- Fondazione PTV Policlinico Tor Vergata, 90352, Unit of Urology,Fondazione PTV Policlinico Tor Vergata, Rome, Italy, Viale Oxford 81, Roma, Italy, 00133;
| | - Eleonora Rosato
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | - Angelica Fasano
- University of Rome Tor Vergata Faculty of Medicine and Surgery, 60259, Roma, Italy;
| | | | - Stefano Germani
- Fondazione PTV Policlinico Tor Vergata, 90352, Unit of Urology,Fondazione PTV Policlinico Tor Vergata, Rome, Italy, Roma, Italy;
| | - Enrico Finazzi Agrò
- Universita degli Studi di Roma Tor Vergata, 9318, Experimental Medicine and Surgery - Urology Unit, Roma, Italy;
| | - Alessandra Nardi
- University of Rome Tor Vergata Macro Area of Mathematical Physical and Natural Sciences, 531262, Mathematics, Roma, Lazio, Italy;
| | - Roberto Miano
- Tor Vergata University, Urology, Via Giulio Curioni 131, Rome, Italy, 00157.,Italy;
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Moore M, Mabedi C, Phull M, Payne SR, Biyani CS. The utility of Urological Clinical and Simulation Training for Sub-Saharan Africa. BJU Int 2022; 129:563-571. [PMID: 35338556 DOI: 10.1111/bju.15731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Madeline Moore
- Urology Registrar Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Charles Mabedi
- Consultant Urologist, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | - Stephen R Payne
- Urolink Secretary, British Association of Urological Surgeons
| | - Chandra Shekhar Biyani
- Department of Urology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Co-Director Surgical Cadaveric Simulation Lab, University of Leeds, Leeds
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Aydın A, Ahmed K, Abe T, Raison N, Van Hemelrijck M, Garmo H, Ahmed HU, Mukhtar F, Al-Jabir A, Brunckhorst O, Shinohara N, Zhu W, Zeng G, Sfakianos JP, Gupta M, Tewari A, Gözen AS, Rassweiler J, Skolarikos A, Kunit T, Knoll T, Moltzahn F, Thalmann GN, Lantz Powers AG, Chew BH, Sarica K, Shamim Khan M, Dasgupta P. Effect of Simulation-based Training on Surgical Proficiency and Patient Outcomes: A Randomised Controlled Clinical and Educational Trial. Eur Urol 2021; 81:385-393. [PMID: 34789393 DOI: 10.1016/j.eururo.2021.10.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 09/09/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. OBJECTIVE To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. DESIGN, SETTING, AND PARTICIPANTS This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. INTERVENTION Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. RESULTS AND LIMITATIONS A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72-2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39-2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91-1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. CONCLUSIONS Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. PATIENT SUMMARY This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.
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Affiliation(s)
- Abdullatif Aydın
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK.
| | - Kamran Ahmed
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Department of Urology, King's College Hospital NHS Foundation Trust, King's Health Partners, London, UK
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nicholas Raison
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | | | - Hans Garmo
- School of Cancer and Pharmaceutical Studies, King's College London, London, UK
| | - Hashim U Ahmed
- Department of Surgery and Cancer, Imperial College London, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Furhan Mukhtar
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Ahmed Al-Jabir
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Oliver Brunckhorst
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wei Zhu
- Department of Urology, Minimally Invasive Surgery Centre, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Centre, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashutosh Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Serdar Gözen
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Jens Rassweiler
- Department of Urology, SLK Kliniken, University of Heidelberg, Heilbronn, Germany
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Kunit
- Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Knoll
- Department of Urology, Klinikum Sindelfingen-Böblingen, University of Tübingen, Sindelfingen, Germany
| | - Felix Moltzahn
- Department of Urology, University of Bern, Bern, Switzerland
| | | | | | - Ben H Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kemal Sarica
- Department of Urology, Biruni University Hospital, Istanbul, Turkey
| | - Muhammad Shamim Khan
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King's College London, King's Health Partners, London, UK; Urology Centre, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK
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