To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy.
A customised questionnaire was designed in a 4-step iterative process incorporating a systematic review of the literature and critical analysis of topics/questions by six endourologists.
The 19-item questionnaire interrogated perceptions, practice patterns and key areas of uncertainty regarding ureteroscopic IRP, and was disseminated via urological societies, networks and social media to the international urological community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analysed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume.
Responses were received from 522 urologists, practicing in six continents. The individual question response rate was >97%. Most (83.9%,437/515) respondents were practicing at consultant/attending level. An endourology fellowship incorporating stone management had been completed by 59.2% (307/519). The vast majority of respondents (85.4%,446/520) scored the perceived clinical significance of IRP during ureteroscopy ≥7/10 on a Likert scale. Concern was uniformly reported, with no difference between respondents with and without a high annual case volume (p=0.16). Potential adverse outcomes respondents associated with elevated ureteroscopic IRP were urosepsis (96.2%,501/520), collecting system rupture(80.8%,421/520), postoperative pain (67%,349/520), bleeding (63.72%,332/520) and long-term renal damage (26.1%,136/520). Almost all participants (96.2%,501/520) employed measures aiming to reduce IRP during ureteroscopy. Regarding the perceived maximum acceptable threshold for mean IRP during ureteroscopy, 30mmHg(40cmH2O) was most frequently selected (23.2% (119/463)), with most participants (78.2%,341/463) choosing a value ≤40mmHg.
This is the first large-scale analysis of urologists' perceptions of ureteroscopic IRP. It identifies high levels of concern amongst the global urological community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains with regard to appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.
Journal of endourology. 2023 Sep 19 [Epub ahead of print]
Stefanie M Croghan, Bhaskar K Somani, Shane W Considine, Kieran Breen, Barry B McGuire, Rustom P Manecksha, Vineet Gauhar, Bm Zeeshan Hameed, Sorcha O'Meara, Esteban Emiliani, Ana María Autrán Gomez, Deepak Agarwal, Tarik Emre Sener, Fergal J O'Brien, Necole M Streeper, Christian Seitz, Niall F Davis
Royal College of Surgeons in Ireland, 8863, Strategic Academic Recruitment (StAR) Programme, Dublin, Ireland., University Hospitals Southampton NHS Trust, Urology, Southampton, United Kingdom of Great Britain and Northern Ireland., Royal Free London NHS Foundation Trust, 4965, Urology, London, United Kingdom of Great Britain and Northern Ireland; ., SVUH, 58038, Urology, Dublin, Ireland; ., SVUH, 58038, Urology, Dublin, Ireland; ., Tallaght University Hospital, 57976, Urology, Dublin, Ireland., Ng Teng Fong General Hospital, 242949, NUHS, Urology, Singapore, Singapore; ., Kasturba Medical College Manipal, Manipal Academy of Higher Education, Urology, Kasturba Medical College, Manipal, Manipal, Karnataka, India, 576104; ., Fundacio Puigvert, 16444, Urology , Barcelona, Cataluña, Spain; ., Lyx Urology, 536052, Urology, Madrid, Comunidad de Madrid, Spain., University of Minnesota, 5635, Urology, Minneapolis, Minnesota, United States; ., Marmara University School of Medicine, Urology, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No: 10 Üst Kaynarca / Pendik / İSTANBUL, Istanbul, Turkey, 34890; ., Royal College of Surgeons in Ireland, 8863, Tissue Engineering Research Group, Dublin, Ireland; ., Penn State Health Milton S Hershey Medical Center, 12311, Urology, 500 University Drive, Hershey, Pennsylvania, United States, 17033-2360; ., Medical University of Vienna, 27271, Urology, Wien, Austria., Beaumont Hospital, 57978, Department of Urology, Dublin, Ireland.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37725588