The widespread adoption and rapid integration of new technologies and techniques in endoscopic and laser bladder interventions, particularly endoscopic enucleation, have led to new types of bladder injuries. This underscores the need for an intraoperative injury classification system. This study aims to develop and validate the Bladder Injury Classification System for Endoscopic Procedures (BICEP), which standardizes the classification of complications and intervention requirements.
This mixed-methods study involved experts from the European Association of Urology Section of Urotechnology to standardize and validate the BICEP classification system. An iterative process involving focus groups, expert surveys, and revisions assessed clarity, relevance, comprehensiveness, and practicality. Validity was confirmed through expert surveys conducted in two rounds for face and content validity, using a 5-point Likert scale to correlate ratings with expected outcomes.
The novel BICEP classification system categorizes bladder injuries into ten subcategories with scores ranging from 0 to 4, reflecting injury severity and management requirements. Face validity was demonstrated by a 95% consensus on the system's clarity, relevance, and comprehensiveness. Content validity was supported by high acceptance rates in expert surveys, with average scores of 4.53 and 4.58 in the first and second rounds, respectively. This demonstrates strong support for its applicability in clinical practice. However, the primary limitation is the lack of external validation.
Our study demonstrates that the BICEP system is a robust and comprehensive classification system, with strong support for its face and content validity. The BICEP system is a proposal based on expert opinion, and additional studies are necessary to ensure its widespread adoption and efficacy.
Our study addressed the critical need for standardized classification in the increasingly widespread context of urology endoscopic technologies by focusing on intraoperative evaluation, reporting, and standardization of bladder injuries. This study provides a globally standardized basis for the classification and treatment of bladder injuries in urology endoscopic procedures.
European urology focus. 2024 Sep 25 [Epub ahead of print]
Burak Akgül, Atınc Tozsin, Theodoros Tokas, Salvatore Micali, Thomas Herrmann, Giampaolo Bianchi, Cristian Fiori, Nurullah Altınkaya, Gernot Ortner, Thomas Knoll, Karin Lehrich, Axel Böhme, Nariman Gadzhiev, Mohamed Omar, Ioannis Kartalas Goumas, Javier Romero Otero, Abdullatif Aydın, Lukas Lusuardi, Christopher Netsch, Azhar Khan, Francesco Greco, Prokar Dasgupta, Lütfi Tunc, Jans Rassweiler, Ali Serdar Gozen, Kamran Ahmed, Selçuk Güven
Department of Urology, Trakya University School of Medicine Hospital, Edirne, Turkey., Department of Urology, University General Hospital of Heraklion, Athens, Greece., Department of Urology, University of Modena and Reggio Emilia, Modena, Italy., Department of Urology, Kantonspital Thurgau AG Pfaffenholzstrasse, Frauenfeld, Switzerland., Department of Urology, Università degli studi di Modena e Reggio Emilia, Modena, Italy., Department of Oncology, University of Turin, Turin, Italy., Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey., Department of Urology, General Hospital Hall I.T, Tirol, Austria., Klinikum Sindelfingen-Boeblingen, Sindelfingen, Germany., Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany., Saint-Petersburg State University Hospital, St. Petersburg, Russia., Department of Urology, Menoufiya University Hospital, Menoufiya, Egypt., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Department of Urology, ROC Clinic and Fundación Investigación HM Hospitales, Madrid, Spain., Faculty of Life Sciences and Medicine, King's College London, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK., Department of Urology, Paracelsus Medical University Salzburg University Hospital, Salzburg, Austria., Asklepios Klinik Barmbek, Abteilung für Urologie, Hamburg, Germany., U.O.C. Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell'Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy., Department of Urology, Acıbadem Hospital, Ankara, Turkey., Department of Urology and Andrology, Danube Private University, Krems, Austria., Department of Urology, Medius Clinic, Ostfildern, Germany., Faculty of Life Sciences and Medicine, King's College London, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, London, UK; Sheikh Khalifa Medical City, Abu Dhabi, UAE; Khalifa University, Abu Dhabi, UAE., Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey. Electronic address: .