Abstract
Urology is a technically demanding specialty, where training opportunities can be limited by patient safety, working hours, and case availability. Simulation-based medical education (SBME) is being increasingly integrated into urology training, offering opportunities for deliberate practice in a structured, reproducible, and risk-free environment. The effectiveness of modern simulation modalities and the extent of clinical skill transfer, however, remain variably reported. This review aims to evaluate the educational outcomes, validity evidence, and clinical skill transfer associated with contemporary simulation-based training in urology. A systematic review was conducted in accordance with PRISMA guidelines. PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and SCOPUS were searched for studies published between 1st January 2015 and 10th November 2025. Eligible designs included randomized trials, cohort studies, and prospective or retrospective evaluations involving urology trainees or consultants. Outcomes of interest were educational performance, technical skill acquisition, and transfer of skills to clinical practice. Risk of bias was assessed using ROBINS-I and the Cochrane Risk of Bias tool. Owing to the heterogeneity of interventions and outcomes, a narrative synthesis was undertaken. Fifteen studies involving 475 participants met the inclusion criteria. Simulation modalities included virtual reality (VR) platforms, multimodal endourological curricula, laparoscopic simulators, and patient-specific 3D-printed or hydrogel models. High-fidelity simulators demonstrated strong face, content, and construct validity, consistently distinguishing between novice and experienced surgeons. Short-format and proficiency-based progression curricula yielded significant improvements in technical skills. Several studies demonstrated predictive validity, showing that VR-trained participants achieved superior operative performance in procedures such as transurethral resection of bladder tumor, ureteroscopy, and laparoscopic nephrectomy. Patient-specific rehearsal models enhanced anatomical understanding and influenced operative planning for complex cases. Common limitations included small sample sizes, single-center designs, and limited reporting of long-term patient outcomes. Modern SBME is an effective and validated tool for developing technical proficiency in urology and demonstrates meaningful transferability to clinical practice. Further multicenter studies using standardized outcomes are required to assess long-term patient impact and evaluate the cost-effectiveness of advanced simulation technologies.