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.

中文翻译：

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泌尿科医师对输尿管镜检查期间肾内压的看法和实践模式：全球横断面分析的结果。

目的：探讨泌尿科医师对输尿管镜检查 (URS) 期间肾内压 (IRP) 的看法和实践模式。方法：通过 4 步迭代过程设计定制调查问卷，其中包括六位腔内泌尿科医生对文献的系统回顾和对主题/问题的批判性分析。该调查问卷包含 19 项内容，询问了人们对输尿管镜 IRP 的看法、实践模式和不确定的关键领域，并通过泌尿外科协会、网络和社交媒体向国际泌尿外科界传播。目前从事泌尿外科工作的顾问/主治医师和实习生有资格做出回应。使用描述性统计和卡方检验对定量反应进行汇编和分析，并按手术量进行亚组分析。结果：收到了来自六大洲执业的 522 名泌尿科医生的回复。个别问题回复率>97%。大多数（83.9%，437/515）受访者处于顾问/主治级别。包含结石管理的腔内泌尿外科研究金已完成 59.2% (307/519)。绝大多数受访者 (85.4%, 446/520) 采用 Likert 量表对 URS ≥7/10 期间 IRP 的感知临床意义进行评分。一致报告了担忧，年度病例量高和不高的受访者之间没有差异（p = 0.16）。与输尿管镜 IRP 升高相关的潜在不良后果受访者包括尿脓毒症 (96.2%, 501/520)、集合系统破裂 (80.8%, 421/520)、术后疼痛 (67%, 349/520)、出血 (63.72%, 332/ 520）和长期肾损害（26.1%，136/520）。几乎所有参与者 (96.2%, 501/520) 在 URS 期间都采取了旨在减少 IRP 的措施。关于 URS 期间平均 IRP 的感知最大可接受阈值，最常选择 30 mm Hg (40 cm H2O) [23.2% (119/463)]，大多数参与者 (78.2%, 341/463) 选择 ≤40 的值毫米汞柱。结论：这是泌尿科医师对输尿管镜 IRP 看法的首次大规模分析。它引起了全球泌尿外科界的高度关注，几乎一致认为 IRP 升高与不良临床结果相关。Equipoise 仍然关注术中适当的 IRP 限制以及确保遵守这些限制的最合适的技术策略。