Al-Terki AE. et al., 2026: . Development and Implementation of the Selection, Entry, Lithotripsy, Exit, and CT (SELECT) Mnemonic and Checklist: A Structured Approach to Urolithiasis Assessment and Management for Urology Trainees and Junior Urologists.

Al-Terki AE, Yaiesh S, Khan RN, Maqames S, Al-Shaiji TF, Al-Soudan Al-Anzi N.
Cureus. 2026 Jan 9;18(1):e101200. doi: 10.7759/cureus.101200

Abstract

Introduction Urolithiasis is a common condition in urological practice, with a particularly high burden in the Middle East due to dietary and lifestyle factors. Effective evaluation and management require a systematic approach, yet trainees often struggle with decision-making due to patient- and stone-related variability. To address these challenges, we developed the selection, entry, lithotripsy, exit, and CT (SELECT) mnemonic and checklist, a structured five-tier systematic approach designed to streamline renal stone assessment and management. Methods A panel of endourologists and educators identified key challenges in urolithiasis management among urology residents. A pre-implementation survey was conducted among 28 residents in the Kuwait Board of Urology program to assess confidence and challenges in renal stone evaluation and keenness for a mnemonic. Following the development of the SELECT mnemonic and checklist, trainees were introduced to the tool and instructed to utilize it over four weeks. A post-implementation survey was then conducted, and feedback was collected from both trainees and training supervisors. Results Before implementation, only 25% of residents reported confidence in assessing renal stone characteristics and selecting treatment modalities. Post-implementation, 84% reported improved confidence in assessment, and 80% felt more assured in treatment selection. Supervisors also noted improved diagnostic accuracy and decision-making among trainees. The mnemonic reduced reliance on senior guidance, although time constraints were a reported limitation. Conclusion The SELECT mnemonic and checklist offer a structured, evidence-based approach to renal stone management, improving trainee confidence and decision-making. External validation and potential scoring integration could further enhance their utility in urological education and clinical practice.

Comment Peter Alken

A very interesting study on how to improve residents’ performance and, at the end, therapeutic outcome. It seems to be work in progress, as feedback from residents in the post-implementation survey showed only average usage and acceptance rates.

Peter Alken