Although apprenticeship served surgeons in training well a hundred years ago, the complexity of surgical technology in the 21st Century has exponentially increased the demands on surgical education. Pelvic trainers can provide the necessary basic training for endoscopic and laparoscopic surgeons, but it usually is necessary to incorporate live-animal or cadaver practice or both to train fully in today's complex procedures. Advances in computer and materials technology have allowed the development of realistic simulators, but validation studies are required. Reliability is the reproducibility and precision of the test or testing device. Validity measures whether the simulator actually is teaching or evaluating what it is intended to teach or measure. Face validity relates to the realism of the simulator; content validity is a judgment of the appropriateness of the simulator as a teaching modality. Criterion validity compares the evaluation results from the new simulator with those of the old technique. The two types of criterion validity are concurrent - the extent to which the simulator correlates with the "gold standard" - and predictive - the extent to which the simulator predicts future performance. Construct validity indicates whether the simulator is able to distinguish the experienced from the inexperienced surgeon. For competency assessment, performance on a simulator should predict, or at least correlate with, an individual's performance in the operating room. A variety of endourologic models and simulators have been described, but only a few have been subjected to validity testing. An even greater number of simulators has been developed for laparoscopic skills training, but none is dedicated to training for laparoscopic urology. Surgical simulation must be used within an effective learning environment, underpinned by knowledge and professional attitudes.

The 3 major radiographic features of the lower pole calix (infundibulopelvic angle, and infundibular length and width) can be easily measured on standard IVP using a ruler and protractor. Each factor individually has a statistically significant influence on stone clearance after ESWL. A wide infundibulopelvic angle or short infundibular length and broad infundibular width regardless of infundibulopelvic angle are significant favorable factors for stone clearance following ESWL. Conversely, these factors have a cumulatively negative effect on the stone clearance rate after ESWL when they are all unfavorable. In ureteroscopy spatial anatomy has less of a role in regard to stone clearance but it may have a negative impact when there is uniformly unfavorable anatomy.

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Laparoscopic radical nephrectomy, although technically demanding, is a viable alternative for managing localized renal tumors up to 10 cm. It affords patients with renal tumors an improved postoperative course with less pain and a quicker recovery while providing similar efficacy at 2-year followup for patients with T1 and T2 tumors.