Ureter Visualization With Transvaginal Ultrasound

Abstract

Objectives-To evaluate the learning curve of gynecologic surgical fellows (ie, in training) to properly identify the ureters in real time while simultaneously performing and interpreting transvaginal ultrasound (TVUS) examinations. Methods-We performed a prospective study, which took place at 2 centers in Sydney, Australia, from December 2017 to December 2018. Three fellows (F1-F3), of varying prestudy ultrasound (US) experience, were recruited to participate. One hundred fifty predetermined examinations were planned. A TVUS examination was performed by the study reference standard (an expert in gynecologic US). Subsequently, the fellows performed a focused component to identify bilateral ureters, having been blinded to the patient's clinical history and reference standard findings. Immediate feedback and hands-on teaching were provided after each of the fellow's evaluations were complete. To evaluate the number of scans needed to gain competency, the cumulative summation test for the learning curve was used. Results-A total of 150 examinations were performed on 145 patients. One patient had a single ureter, and 1 patient had US evidence of hydroureter. The cumulative summation test for the learning curve for bilateral ureter identification showed that F1 did not reach competency by 50 TVUS examinations, whereas F2 and F3 required 41 and 31 TVUS examinations to reach competency, respectively. Conclusions-Contrary to other studies on the topic, this study suggests that although it is feasible for surgical fellows to learn TVUS identification of bilateral ureters, not all fellows can reach competency during a program based on a predefined number of scans. We advocate for an individualized, competencybased medical education model in learning US for identifying the ureters.

The Diagnostic Accuracy of Transvaginal Ultrasound for Detection of Ureteral Involvement in Deep Infiltrating Endometriosis

“…It is necessary to perform between 30 and 50 TVU to properly identify the ureters in real time. 38,39 However, we must stress that we did not compare TVU with MRI. Thus, we cannot ascertain with our data whether TVU is better or worse than MRI for diagnosing ureteral involvement in patients with DIE.…”

“…On the other hand, the learning curve of TVU seems not to be too long. It is necessary to perform between 30 and 50 TVU to properly identify the ureters in real time 38,39 . However, we must stress that we did not compare TVU with MRI.…”

Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases

“…Transvaginal and abdominal ultrasonography are the first-line examinations, as they can detect rectovaginal nodules at the distal third of the ureter and evaluate the degree of hydronephrosis and the thickness of the renal parenchyma [ 18 ]. However, the learning curve of transvaginal ultrasonography to identify bilateral ureter is deep and not all fellows can reach a level of competency by 50 cases examinations [ 19 ]. Magnetic resonance imaging (MRI) is highly accurate in detecting and predicting the type of UE.…”

Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training

“…In our opinion, this limitation precludes the possibility that our data are generalizable. However, in this regard, it is interesting to observe that many studies assessing gynecological training in different fields, such as evaluating pelvic endometriosis [34][35][36], ureteral evaluation [37,38], uterine sliding sign [39], ovarian endometrioma [40] and uterine adenomyosis [41], report similar data regarding the number of assessments needed to achieve competence (around 20 to 50 cases).…”