TY - JOUR
T1 - Perceptions and Practice Patterns of Urologists Relating to Intrarenal Pressure During Ureteroscopy
T2 - Findings from a Global Cross-Sectional Analysis
AU - Croghan, Stefanie M.
AU - Somani, Bhaskar K.
AU - Considine, Shane W.
AU - Breen, Kieran J.
AU - McGuire, Barry B.
AU - Manecksha, Rustom P.
AU - Gauhar, Vineet
AU - Hameed, B. M.Zeeshan
AU - O’Meara, Sorcha
AU - Emiliani, Esteban
AU - Gomez, Ana María Autrán
AU - Agarwal, Deepak
AU - Sxener, Emre
AU - O’Brien, Fergal J.
AU - Streeper, Necole M.
AU - Seitz, Christian
AU - Davis, Niall F.
N1 - Publisher Copyright:
© Mary Ann Liebert, Inc.
PY - 2023/11/1
Y1 - 2023/11/1
N2 - Objectives: To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy (URS). Methods: A customized 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 urologic societies, networks, and social media to the international urologic community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analyzed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume. Results: 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 a 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 URS ‡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) used measures aiming to reduce IRP during URS. Regarding the perceived maximum acceptable threshold for mean IRP during URS, 30 mm Hg (40 cm H2O) was most frequently selected [23.2% (119/463)], with most participants (78.2%, 341/463) choosing a value £40 mm Hg. Conclusions: This is the first large-scale analysis of urologists’ perceptions of ureteroscopic IRP. It identifies high levels of concern among the global urologic community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains regarding appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.
AB - Objectives: To explore beliefs and practice patterns of urologists regarding intrarenal pressure (IRP) during ureteroscopy (URS). Methods: A customized 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 urologic societies, networks, and social media to the international urologic community. Consultants/attendings and trainees currently practicing urology were eligible to respond. Quantitative responses were compiled and analyzed using descriptive statistics and chi-square test, with subgroup analysis by procedure volume. Results: 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 a 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 URS ‡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) used measures aiming to reduce IRP during URS. Regarding the perceived maximum acceptable threshold for mean IRP during URS, 30 mm Hg (40 cm H2O) was most frequently selected [23.2% (119/463)], with most participants (78.2%, 341/463) choosing a value £40 mm Hg. Conclusions: This is the first large-scale analysis of urologists’ perceptions of ureteroscopic IRP. It identifies high levels of concern among the global urologic community, with almost unanimous agreement that elevated IRP is associated with adverse clinical outcomes. Equipoise remains regarding appropriate IRP limits intraoperatively and the most appropriate technical strategies to ensure adherence to these.
KW - endourology
KW - intrarenal pressure
KW - irrigation
KW - perceptions
KW - questionnaire
KW - retrograde intrarenal surgery
KW - retrograde pyelography
KW - survey
KW - ureterorenoscopy
KW - ureteroscopy
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U2 - 10.1089/end.2023.0346
DO - 10.1089/end.2023.0346
M3 - Article
C2 - 37725588
AN - SCOPUS:85176508515
SN - 0892-7790
VL - 37
SP - 1191
EP - 1199
JO - Journal of endourology
JF - Journal of endourology
IS - 11
ER -