WCET 2022: A Global Survey of Ergonomics Practice Patterns and Rates of Musculoskeletal Pain Among Urologists Performing Retrograde Intrarenal Surgery

(UroToday.com) Prolonged static postures and placing your body under various mechanical stressors during surgery poses surgeons at great risk.¹ This biomechanical stress can lead to discomfort, fatigue, and in very severe cases, injury.¹ Despite ergonomics best practices being utilized in other surgical subspecialties, few urologists receive ergonomics training.^2,3 This study was used to characterize the ergonomics practice patterns and rates of musculoskeletal pain for urologists who perform retrograde intrarenal surgery (RIRS).

A web-based survey, distributed via the Endourological Society, the European Association of Urology, and social media, was used. Surgeon anthropometrics and ergonomic factors were compared with the ergonomics best practices. The Nordic Musculoskeletal Questionnaire (NMQ) was used to assess pain. A multivariate logistic regression analysis was performed to evaluate the demographic and ergonomic factors associated with pain data collected via NMQ.

519 of 526 participants completed the survey (99% completion rate). Ninety-three percent of urologists consider ergonomic factors when performing RIRS to reduce fatigue (68%), increase performance (64%), improve efficiency (59%), and reduce pain (49%).

However, only 16% received ergonomics training. Lower confidence in ergonomic technique has been observed in residents/fellows compared to attending surgeons of any career length (Figure 1).

Figure 1. Confidence in Ergonomic Technique while performing RIRS (A) stratified by career length (B) stratified by level of advanced endourology training.

Adherence to proper ergonomic positioning for modifiable factors was highly variable (Figure 2).

Figure 2. Adherence to ergonomic factors 

12-month rates of RIRS-associated pain in ≥1 body part, pain limiting activities of daily living, and pain requiring medical evaluation, as assessed by the NMQ questionnaire were 81%, 51%, and 29%, respectively (Table 1). Annual case volume >150 cases (OR 0.55 [0.35-0.87]) and higher adherence to proper ergonomic techniques (OR 0.67 [0.46-0.97]) were independently associated with lower odds of pain. Limitations include a predominantly male cohort which hindered the ability to assess gender disparities in pain and ergonomic preferences. 

Table 1. Musculoskeletal Pain Attributed to Performing RIRS Using the Nordics Musculoskeletal Questionnaire.


The percentage of urologists adhering to ergonomic best practices is variable and it explains the high rates of musculoskeletal pain among urologists.
Urologists performing high volume (>150 cases/year) RIRS and those with better adherence to ergonomics best practices were less likely to experience MSK pain.
The results underline the importance of ergonomic techniques and may serve as a framework for establishing ergonomic guidelines for retrograde intrarenal surgery.

Presented by: Andrew T. Gabrielson, MD, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Written by: Andrei D. Cumpanas, LIFT Research Fellow, Department of Urology, University of California, Irvine. Twitter: @andreicumpanas the 39th World Congress of Endo urology and Uro-Technology (WCET), Oct 1 - 4, 2022, San Diego, California.

1. Miller DT, Semins MJ. Safety During Ureteroscopy: Radiation, Eyes, and Ergonomics. Front Surg. 2021 Oct 28;8:737337. doi: 10.3389/fsurg.2021.737337. PMID: 34778359; PMCID: PMC8580849.
2. Gabrielson AT, Clifton MM, Pavlovich CP, et al. Surgical ergonomics for urologists: A practical guide. Nat Rev Urol 2021;18:160169.
3. Ong C, Castellani D, Gorelov D, et al. Role and importance of ergonomics in retrograde intrarenal surgery (RIRS): Outcomes of a narrative review. J Endourol 2022;36:112.