Development of the Transurethral Treatment Intermediate Skills Curriculum for TURP (Step 2P): A Cognitive Task Analysis and Delphi Consensus from the European School of Urology

INTRODUCTION: TURP remains a cornerstone endourology procedure and a key training platform for transurethral endoscopic skills. The aim of this study is to develop a transurethral treatment (TUT) Step 2-Prostate curriculum using cognitive task analysis (CTA) and Delphi consensus using the European School of Urology (ESU) methodology. METHODS: An ESU expert working group performed CTA and structured TURP into 10 domains (equipment, patient preparation, resection technique, bleeding prevention, bleeding management, exit strategy, tips and tricks, postoperative care, TUR syndrome, and management of other intraoperative difficulties).CTA-derived statements were assessed in a two-round Delphi (1-9 Likert scale) with consensus defined as ≥80% agreement (7-9) and <10% disagreement (1-3). RESULTS: Of 109 invited experts, 62 completed round 1 and 55 completed round 2. In round 1, 138 statements were evaluated and 116 (84.1%) reached consensus; after reevaluation of 23 statements in round 2, a total of 126/138 (92.7%) statements achieved consensus, and one statement was rejected. Consensus was highest for safety-critical steps and complication management, while lower agreement clustered around equipment choices and some postoperative practices. CONCLUSIONS: A CTA-informed, Delphi-validated ESU TUT Step 2P curriculum was established, defining consensus-based core competencies for TURP and providing a structured foundation for simulation development, standardized teaching, and competency-based assessment.