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The LN-VR simulator did not distinguish between intermediate and experienced participants. The analysis of the learning curves suggests that the tasks measured dexterity in using the simulator rather than an actual improvement of operative skills. We conclude that the LN-VR simulator does not have sufficient construct validity and is therefore, in its present form, not suitable for implementation in a urologic training program.

This study provides an update on the technological aspects of the methods for active removal of renal stones. Currently, extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are the available options. Findings are based upon recent literature from the PubMed database and the European Association of Urology (EAU) guidelines. ESWL remains the option of choice for stones with diameter ≤ 20 mm due to its low invasive character, whereas PCNL is the standard for stones with diameter > 20 mm because of its high stone-free rates. Although ESWL treatment has become more patient friendly, its efficacy has not improved. On the other hand, URS has gained renewed interest due to new technological developments and improved treatment methods.

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