![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_40_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=8Tcir0WJ 40w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=1mRhs4wi 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=XioEEvED 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=lkvb87P_ 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=4WTOsNkK 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=B6d7XHsg 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=Sh_c33-k 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=rSwGF-Os 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=N7CWL981 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=ZfzbVRMw 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600_3_1/public/media/images/2023-11/vesicourethral_anastomosis_11-21-23.jpg?itok=qrzeEiEw 1600w)
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)
- 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." 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)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/1.needlepos.png?itok=O-ogh3bV 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/1.needlepos.png?itok=h_gbig8Z 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/1.needlepos.png?itok=cv2PGu2h 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/1.needlepos.png?itok=5u2h4F_n 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/1.needlepos.png?itok=CZGAUzEn 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/1.needlepos.png?itok=sicZnp-8 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/1.needlepos.png?itok=wfUBa_aL 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/1.needlepos.png?itok=RbBHmBCs 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/1.needlepos.png?itok=lRri4-Hc 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/1.needlepos.png?itok=5RDWcJks 1600w)
Score needle entry (1-5 points)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/2.needleentry.png?itok=vj0HEl8f 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/2.needleentry.png?itok=ut2LrLVw 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/2.needleentry.png?itok=J8KCLOUW 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/2.needleentry.png?itok=s9VduiYB 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/2.needleentry.png?itok=49DrgiWN 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/2.needleentry.png?itok=KbxHbTOQ 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/2.needleentry.png?itok=lF0Z6tMx 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/2.needleentry.png?itok=jdHrEggh 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/2.needleentry.png?itok=bE6lvaij 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/2.needleentry.png?itok=nEx-5TXW 1600w)
Score needle driving/tissue trauma (1-5 points)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=4WU6pTCc 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=SRmAwOv1 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=2iC_bmAm 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=bYOALX-8 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=UQ17yR-n 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=I-to9x0k 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=yHI3hbnR 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=tD4UWU7v 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=fFpn-gT8 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/3.needledrivingandtissuetrauma.png?itok=hCyyc1Nq 1600w)
Score suture placement (1-5 points)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/4.sutureplacement.png?itok=vJpNG8ic 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/4.sutureplacement.png?itok=p05Do3PL 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/4.sutureplacement.png?itok=gyReIkEc 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/4.sutureplacement.png?itok=3P17rQuj 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/4.sutureplacement.png?itok=6wb7THjt 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/4.sutureplacement.png?itok=RNkIj9uk 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/4.sutureplacement.png?itok=Ml7M5C9p 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/4.sutureplacement.png?itok=8b-gOJHm 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/4.sutureplacement.png?itok=Z1ErI2cz 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/4.sutureplacement.png?itok=U5Q4l9_O 1600w)
Score tissue approximation (1-5 points)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/5.tissueapproximation.png?itok=eJ3ooN0d 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/5.tissueapproximation.png?itok=XpeSG0uA 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/5.tissueapproximation.png?itok=HyBy6tFm 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/5.tissueapproximation.png?itok=wKD8r6er 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/5.tissueapproximation.png?itok=qtMffWAz 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/5.tissueapproximation.png?itok=FNGnc7ut 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/5.tissueapproximation.png?itok=ei41VyyF 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/5.tissueapproximation.png?itok=Uzr57ht_ 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/5.tissueapproximation.png?itok=pEmL28Ux 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/5.tissueapproximation.png?itok=StJ9Z-GZ 1600w)
Score knot tying (1-5 points)
![](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/general/2024-03/6.knots_.png?itok=Ys75PdD5 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/general/2024-03/6.knots_.png?itok=CKOKrkNW 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/general/2024-03/6.knots_.png?itok=JLLxdYAZ 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/general/2024-03/6.knots_.png?itok=yG77l2Rx 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/general/2024-03/6.knots_.png?itok=dRSiKpC9 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/general/2024-03/6.knots_.png?itok=3zMgvdbC 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/general/2024-03/6.knots_.png?itok=AVBoesPN 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/general/2024-03/6.knots_.png?itok=C6it9_pw 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/general/2024-03/6.knots_.png?itok=z8Tcfjet 1280w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/general/2024-03/6.knots_.png?itok=0oheABZz 1600w)
Calculate Your Score
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