Radiation Exposure, Knowledge, and Compliance in Upper Tract Urological Surgery: A Systematic Review

The use of ionizing radiation in urology has grown significantly, increasing occupational risks to urologists. Despite established safety guidelines and protective equipment, adherence remains inconsistent due to limited education and systemic barriers. This review evaluates current practices in upper tract urological surgeries, identifies factors contributing to poor compliance, and explores strategies to enhance radiation safety in urology. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, 209 articles were screened, with 22 final studies meeting inclusion criteria. Two independent reviewers screened manuscripts to determine study eligibility, and a Cochrane Risk of Bias was performed. The findings revealed that trunk personal protective equipment (PPE) had the highest compliance, while eye and hand protection were the least used. An educational intervention led to a 99.9% increase in PPE compliance. Knowledge gaps were prevalent, with 63-64% of respondents reporting no formal training. Higher knowledge correlated with improved safety practices. PPE use significantly reduced radiation exposure: eyes (90%), hands (50%), thyroid (95%), and trunk (95%). Protocol modifications such as pulsed fluoroscopy and additional shielding were consistently associated with reduced exposure. These findings underscore the critical role of PPE and education in curtailing radiation exposure among urologists and surgical staff in upper tract urological surgery. Emphasizing proper training is paramount to instilling adherence to PPE protocols and implementing procedural techniques aimed at minimizing radiation exposure. The objective of this systematic review was to comprehensively assess existing literature, focusing on the efficacy of PPE, radiation safety protocols, educational initiatives, and procedural adaptations aimed at reducing radiation exposure among urological practitioners.