Archivio Italiano di Urologia e Andrologia 2022; 94, 3 300 ORIGINAL PAPER No conflict of interest declared. taking place on a monthly basis. The course is usually supporting 2-3 international trainees per course and includes one day of wet lab training in pigs and one full day of live surgery, where trainees are participating as first and assisting surgeons in the operation of several PCNL cases under the proctoring of a highly skilled sur- geon. After the training of more than 90 physicians we conducted an online survey examining whether particu- lar training course and PCNL intensive hands on training courses in general have any impact in the daily surgical practice of attending trainees. MATERIALS AND METHODS Survey and training physician characteristics: A survey consisting of 26 questions (2x demographic information, 10x pre and 10x post training experience and surgical preferences, 4x overall impressions from the course) was distributed online to a total of 91 trainees that had com- pleted the course. All attending physicians were certified urologists with various previous experience in PCNL. Their ethnicity varied from Europe (Germany:15, France:11, United Kingdom:8, Austria:8, Poland:8, Russia:7, Bulgaria:5, Switzerland:4, Greece:4, Netherlands:4, Cyprus:3, Italy:2, Slovenia:2, Hungary:1, Serbia/Montenegro:1, Spain:1), Africa (South Africa:2, Morocco:1) and middle East (Qatar:2, Kuwait:1, Lebanon:1). A total of 64 trainees responded to our online survey leading to a 70.3% response rate. Mean age of responding physicians was 44 years (range: 32-68). Self reported experience prior to the course was poor (defined as < 10 cases) in 31.3%, intermediate (defined as > 10 and < 50 cases) in 28.1% and good (defined as > 50 cases) in 40.6% of attending surgeons. Hands on Wet lab training protocol: A female pig weight- ing more than 30 Kg was anesthetized and placed in the supine position. Under cystoscopic and fluoroscopic guidance a 7 Fr ureteral catheter was advanced to each kidney. The animal was then placed in prone position and a retrograde pyelography was performed. C-arm was then placed at 30 degrees perpendicular to the long axis of the pig and target calyx or renal pelvis was selected. Following a small skin incision an 18G diamond tip nee- dle was advanced towards target in a bull’s eye fashion. After adequate penetration of the needle, the C-arm was rotated to zero degrees and the depth of puncture was Objectives: The clinical value and efficiency of hands-on training courses in percutaneous nephrolithotomy (PCNL) remains undocumented. During the last 9 years, a two-day international intensive hands-on training course in fluoroscopic guided prone PCNL is taking place in our department on a monthly basis. Course includes wet lab training in the porcine model and live surgery training. In this work we report the outcomes of a survey send to course participants questioning the impact of the course to their clinical practice. Materials and methods: A survey consisting of 26 questions was distributed online to a total of 91 trainees that had completed the course. Comparison of pre and post course surgical practices was performed using the "N-1" Chi-squared test. Results: A total of 64 trainees responded to our online survey with 55.6% and 41.3% reporting a modest or major impact to their practice accordingly. Notable changes in puncture and dilation technique were evidenced while a uniform reduction in puncture and operative times was documented. 79.4% responded that the course increased the safety of their procedure, 73% that it reduced operating times, 39.7% that increased their stone free rates, 23.8% that reduced their complications and 23.8% that induced to change their instrumentation with respect of that they were using in the past. Subgroup analysis including only well experienced surgeons revealed a similar impact to their practice. Conclusions: In the proper setting, an intensive hands-on PCNL course can have a significant impact on attending physicians. Participation to such events even for experienced surgeons should be encouraged. KEY WORDS: PCNL; Hands-on; Wet lab; Training; Surgical skills. Submitted 4 August 2022; Accepted 20 August 2022 INTRODUCTION Proper training in percutaneous nephrolithotripsy (PCNL) is of outmost importance to ensure high efficacy of PCNL and reduce its potential morbidity (1). Currently, PCNL training is provided by structured residency and fellow- ship programs worldwide and is further supported by individual theoretical and hands on training courses. Nevertheless, the clinical value and efficiency of the latter short-term courses has never been investigated. During the last 9 years, in the University Hospital of Patras in Greece, a two-day international intensive hands on training course in fluoroscopic guided prone PCNL is Hands on wet lab and live surgery training in PCNL: Any impact to surgical skills of attending surgeons? Iason Kyriazis 1 , Panagiotis Kallidonis 1 , Eleni Kyrkopoulou 2 , Theodoros Spinos 1 , Evangelos Liatsikos 1 1 Department of Urology, University of Patras, Greece; 2 Department of Economics, Athens University of Economics and Business, Greece. DOI: 10.4081/aiua.2022.3.300 Summary