Figure 1. Faculty and course participants at the 2023 AUA hands-on percutaneous nephrolithotomy course.

Figure 2. Dr Chi and course attendees learn hands-on renal ultrasound access techniques.

Figure 3. Dr Duane Baldwin and course attendees learn hands-on fluoroscopic-guided renal access techniques.

Figure 4. Dr Helena Chang and course attendees learn hands-on tricks for performing endoscopic combined intrarenal surgery.

Figure 5. Dr Ian Metzler with course attendees learning hands-on mini-percutaneous nephrolithotomy techniques.

The inception of a hands-on percutaneous nephrolithotomy (PCNL) skills course as a 4-hour “short course” at the annual AUA conference with a series of more in-depth regional day and half-day courses happened through a series of phone meetings and emails with Dr Ralph Clayman, Dr Jaime Landman, Dr Arthur Smith, Dr David Hoenig, me, and the AUA staff throughout 2014. Building on this strong foundation, the course has continued to be relevant and adaptable to needs around the skillset for PCNL throughout the years. At AUA 2023, 45 attendees chose to advance their skill set for percutaneous renal access at our tips and techniques course this year (Figure 1). Thoughtful synchronization and coordination with Dr Thomas Chi’s morning course on advanced ultrasound techniques provided a full day of synergistic hands-on learning opportunities. The first hour of the afternoon course was highlighted by an outstanding lecture from Dr Duane Baldwin (Loma Linda, California) reminding us of the dangers of radiation and providing us with practical strategies for minimizing its use during PCNL. This was followed by a thoughtful lecture by Dr Benjamin Canales (University of Florida [Gainesville]) empowering the learners with preoperative decision-making principles and guidelines for case and access site selection. Dr Nicole Miller (Vanderbilt) introduced positioning considerations and mini-PCNL equipment and techniques which continue to steadily gain traction in the literature and in our practices. I provided a lecture on steps and tips for fluoroscopic access and endoscopic combined intrarenal surgery and Dr Thomas Chi (University of California, San Francisco) provided the complementary skill set for ultrasound-guided access techniques. Dr Zeph Okeke (Northwell) rounded out the lectures by providing a review of exit strategies and complications with tips on how to avoid them.

This year, we provided 2 full hours of proctored hands-on learning opportunities with 4 skills stations. The Chi/Sur butcher model provided an opportunity to hone in on ultrasound renal visualization and access skills (Drs Okeke, Chi, and Raskolnikov; Figure 2). The Simagine fluoroless C-arm trainer facilitated the attendees’ ability to successfully acquire and demonstrate the skills necessary for fluoroscopic-guided renal access (Drs Baldwin, Hoenig, and Leavitt; Figure 3). The Simagine ECIRS Ease models provided a hands-on opportunity to practice the coordination and communication skills necessary to obtain through-and-through access with a combined retrograde-antegrade approach to dealing with complex or large stones (Chang, Canales, Sweet; Figure 4) and the University of Washington CREST nephrolithotomy models allowed learners to get introduced to mini-percutaneous instrumentation and techniques (Drs Miller, Knudsen, and Metzler; Figure 5). We rounded out the course with a town hall/panel of difficult PCNL case presentations by Drs Ian Metzler (University of California, San Francisco) and Helena Chang (Kaiser Permanente San Francisco) that highlighted the utilization of all the skills/techniques learned during the course. Our vibrant faculty were energized by our enthusiastic learners this year as there seemed to be a transition from exploration to motivated implementation. Learners were noted to have more baseline skills than in years past and came in with very targeted learning goals that were met by the course. We anticipate that the course will continue to contribute to the trend of urologists safely, successfully, and skillfully performing their own percutaneous access which has been shown to improve outcomes in patients undergoing PCNL.^1,2