Intrarenal Pressure Monitoring During Ureteroscopy: A Delphi Panel Consensus

Abstract

Background and objective

Elevated intrarenal pressure (IRP) may increase the risk of complications in patients undergoing ureteroscopy. As there is limited clarity on a threshold value for high IRP, how to manage high IRP, or which patients are at greater risk of complications due to high IRP, we used the Delphi methodology to understand expert opinion in this area.

Methods

The Delphi process comprised two online surveys and an in-person meeting. During the in-person meeting, areas of disagreement and consensus were explored. Consensus statements were developed and voted on to determine the level of consensus. The study was granted a waiver by HML IRB Research and Ethics (reference number 2193).

Key findings and limitations

The pan-European panel started with 12 and ended with 11 experienced endourologists. Eleven consensus statements were developed. The statements cover topics such as the definition of high IRP, complications linked to high IRP, and patient risk factors for these complications. After anonymous voting, consensus was achieved for all the statements. Two had a strong level and nine had a moderate level of agreement. There was no consensus on an IRP threshold, although the majority would be concerned for patient safety at a pressure above 61–80 cm H₂O.

Conclusions and clinical implications

Any IRP above normal physiological levels should be considered high. High IRP during ureteroscopy is a concern for patient safety. It is important to understand links between high IRP, patient characteristics, and complications. We call for additional research to better understand these risks and to inform refinements to clinical practice.

Patient summary

A group of experts were asked their opinion on pressure within the kidney (intrarenal pressure, IRP) during a procedure called ureteroscopy (URS), when a narrow telescope is passed through the bladder and into the tube connected to the kidney. Statements that the panel agreed on were developed. These statements show that there is a concern about high IRP during URS as it may be linked to a higher risk of complications for the patient. More research is needed to better understand high IRP and its link to patient outcomes.