Anatomic Module: Vesicourethral Anastomosis

On this page:

• Supplies and Setup​
• Instructions and Objectives​
• Scoring Rubric
• Scorecard

Supplies​ and Setup

Supplies

• Suture board material (we use the Sim*Vivo suture material(link is external and opens in a new window))​
• Marking pen​
• 24Fr Foley catheter​
• Standard dish sponge​
• Clipboard​
• Thick non-absorbable suture (we use 2-0 nylon)​
• Anastomosis suture (we use 2 4-0 monofilament absorbable sutures)​
• Paper cup​
• Scissors

Set up​

• Cut a 1cm diameter hole in your suture material. This will be the transected bladder neck.​
• Using your marking pen, mark your bilateral ureteral orifices (UOs) about 1cm diagonally away from your bladder neck in each direction​.
• Fold your suture material in half and clip it into the clipboard with your bladder neck facing away from the clip and the UOs on the bottom side.​
• Cut the end off of a 24Fr Foley catheter. This will be the transected urethra.​
• Moisten your sponge and wrap it lengthwise around the catheter. Use your nonabsorbable suture to keep the sponge in place. This will be the periurethral tissue.​
• Punch out the bottom of your paper cup. Cut off the top half of the rim of the cup as well. This will be the bony pelvis.​
• Secure the pelvis and urethra to your clipboard using 2 rubber bands. This should be positioned such that the cut end of the urethra comes into contact with the bladder neck when the bladder neck is on a very mild amount of stretch.​
• Prepare your anastomosis suture(s) as you like. We cut two sutures to 6-inch pieces and tie them together at their tails.

Objectives

Scoring Rubric

We use a modified version of the "RACE Criteria(link is external and opens in a new window)." Ideally, an expert surgeon will do the grading, but you can also grade yourself.​

Did the gamer complete the anastomosis model in the allotted time (20 min)? ​

• Yes (20 points) ​
• No: approximated all tissue but did not tie the suture completely (16 points) ​
• No: completed the posterior half but NOT the anterior (8 points)
• No: completed NEITHER the anterior NOR the posterior half (0 points)

Score needle positioning (1-5 points)

Score needle entry (1-5 points)

Score needle driving/tissue trauma (1-5 points)

Score suture placement (1-5 points)

Score tissue approximation (1-5 points)

Score knot tying (1-5 points)

Calculate Your Score

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