Functional Urology (FU) is a superspecialty in Urology related with lower urinary tract symptoms; therefore, it is essential for every urologist to have a good training in this area. The aim of this study is to describe the situation in Spain nowadays regarding the training in Functional Urology and Urodynamics and to identify possible shortcomings.

Transversal, descriptive design. A survey with 30 questions was created using the platform Surveymonkey®. From January 16th to March 28th, 2022, it was spread via social media and the mailing list of the Residents’ Group of the Spanish Association of Urology. Inclusion criteria: being resident or young urologist (consultant within the first 5 years of experience).

One-hundred and forty-one complete answers were collected, 71.4% corresponding to residents and 28.6% to young urologists. 

*Functional Urology Units in Spain*
•	74.3% of respondents have a specialised FU unit in their hospital, and 82.1% of these units have dedicated specialised consultants in FU. 
•	44% of hospitals have a multidisciplinary unit for functional disorders, but only a 47.8% of them have a nurse specialised in FU.
•	The number of urodynamic studies (UDS) performed in each unit is highly variable. 
•	Posterior tibial nerve stimulation is performed in 53.9% of hospitals. 
•	Botulinum toxin is injected in 95.7% of the departments.
•	Any FU surgery is done at least once a year in 96.5% of the departments.
•	31.4% perform 10-20 transobturator or retropubic mid-urethral sling surgeries each year, 24.3% perform 20-50 and 11.4% more than 50.
•	Surgical correction of pelvic organ prolapse is performed by Urology in 66.7% of hospitals, Gynaecology in 60.3%, and Urology and Gynaecology together in 16.3% of cases. 
•	Devices for male urinary incontinence are implanted in 87.94% of the hospitals, 45.5% perform between 1-10 each year. 

*Training in FU during the residency*
•	FU training is given by superspecialised consultants in 51.8% of cases.
•	55% of respondents don’t have FU training neither theoretical, nor practical. Theoretical courses have been undergone by 44% of respondents, but 40% have never done one; furthermore, 85% haven’t attended an accredited course. 
•	50.35% have never done an UDS, 38.3% (n=54) have implanted ≤10 slings and 70.2% have never performed an artificial urinary sphincter (AUS) surgery. 
•	A Likert scale between 0 and 5 was designed to ask about the self-confidence in the completion of three common procedures in FU: for UDS and sling surgery it was in average 2.6, but for AUS it was 1,9. 
•	The last question, only intended to be answered by residents, asked about the interest in getting superspecialised in FU: 49.6% considered it attractive, 60.2% do like the functional surgery, and 50.4% don’t have an opinion; however, 57.7% don’t like the patient profile.

Residents in Urology mainly focus their training on oncological urology, and specially in acquiring surgical skills to perform endoscopic, laparoscopic, or robot-assisted procedures (1). However, the number of consultations regarding functional problems both in naïve and post-surgical patients is increasing in the last decades, highlighting the importance of a specific training in FU during the residency. 
There is a lack of information about accredited courses in FU within residents and young urologists, as shown in the results of this survey. Further studies could find the reasons for this matter: tradition of FU superspecialisation in their department, paucity of courses/training in Spanish language, absence of a formal FU rotation during their residency.
One reason for the reduced number of FU procedures undergone by residents could be the FDA warning raised in 2016 about the complications after mesh reconstructive surgery. It has been highlighted by numerous scientific societies that expertise and close supervision is needed when using meshes through the vaginal route (2, 3), and this fear has been translated to other procedures. A specific and formal rotation in FU during the residency in high-volume centres might prepare the residents to face these surgeries and to increase the number and type of procedures they can perform.

Functional Urology is an important and attractive specialty for residents, but shortcomings are found when analysing the number of procedures performed. It is worth underlining the poor confidence of the respondents in the performance of the activities related with the superspecialty.

Gil Moradillo J, Cabrera Meiras F, Alonso Isa M, Lara Isla A, Justo Quintas J, García Rojo E, et al. [Training program on medical urology: Future perspectives.]. Arch Esp Urol. 2018;71(1):114-8.
Chapple CR, Cruz F, Deffieux X, Milani AL, Arlandis S, Artibani W, et al. Consensus Statement of the European Urology Association and the European Urogynaecological Association on the Use of Implanted Materials for Treating Pelvic Organ Prolapse and Stress Urinary Incontinence. Eur Urol. 2017;72(3):424-31.
Resel Folkersma L, Vozmediano Chicharro R, González López R, Jiménez Calvo J, Escribano Patiño G, Conde Santos G, et al. Consensus statement of the Spanish Association Of Urology on the use of meshes in pelvic organ prolapse. Actas Urol Esp (Engl Ed). 2020;44(8):529-34.