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Under pressure: irrigation practice patterns during flexible ureteroscopy.

Bassel Salka1, Jamsheed Bahaee2, Jeff Plott3

  • 1University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI 48109, USA.

Therapeutic Advances in Urology
|June 26, 2023
PubMed
Summary

Flexible ureteroscopy (fURS) irrigation methods vary globally, with North America favoring pressurized bags and Europe preferring gravity systems. Challenges with irrigation occur most often during urothelial tumor biopsy.

Keywords:
irrigationureteroscopy

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Area of Science:

  • Urology
  • Endourology
  • Surgical Techniques

Background:

  • Irrigation parameters during flexible ureteroscopy (fURS) can influence patient outcomes.
  • Current practice patterns for irrigation methods and parameter selection in fURS are not well-documented globally.

Purpose of the Study:

  • To assess common irrigation methods, pressure settings, and problematic scenarios during fURS among international endourologists.

Main Methods:

  • A global survey of Endourology Society members was conducted in January 2021.
  • Data were collected via an online questionnaire, with responses analyzed according to CHERRIES guidelines.
  • Surgeons from North America, Latin America, Europe, Asia, Africa, and Oceania participated.

Main Results:

  • A total of 208 surgeons responded (14% response rate).
  • North American surgeons predominantly used pressurized saline bags (55%), while European surgeons favored gravity saline bags with bulb/syringe systems (45%).
  • Automated systems were most common in Asia (30%); most surgeons used 75-150 mmHg, and urothelial tumor biopsy presented the most irrigation challenges.

Conclusions:

  • Significant variation exists in irrigation practices and parameter selection during fURS worldwide.
  • Regional differences in preferred irrigation methods (pressurized vs. gravity bags) were observed.
  • Automated irrigation systems are not widely adopted, and irrigation difficulties are frequently encountered during tumor biopsies.