Ergonomic strain during retrograde intrarenal surgery: a prospective observational study

Andrea Rubinacci¹, Luigi De Luca², Ugo Amicuzi³, Pasquale Reccia⁴, Luigi Napolitano³, Simone Tammaro¹, Marco Stizzo¹, Dario Del Biondo⁵, Marco De Sio¹, Ciro Imbimbo³, Felice Crocetto³, Celeste Manfredi^1,*, Biagio Barone⁵
1 Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
2 Department of Urology, AORN Antonio Cardarelli, Naples, Italy
3 Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, Naples, Italy
4 Urology Unit, Department of Surgical Sciences, AORN dei Colli, Monaldi Hospital, Naples, Italy
5 Department of Urology, Ospedale San Paolo, ASL Napoli 1 Centro, Naples, Italy
* Corresponding Author: Celeste Manfredi. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.083533

Received 06 April 2026; Accepted 27 May 2026; Published online 02 July 2026

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Abstract

Background: Despite its minimally invasive profile for patients, retrograde intrarenal surgery (RIRS) may impose a considerable physical burden on the operating surgeon. This study aimed to evaluate the ergonomic impact of RIRS by characterizing the distribution and severity of musculoskeletal discomfort. Methods: This observational study included 42 consecutive RIRS procedures performed between January and December 2023 at a high-volume endourology center. Surgeon-reported discomfort was collected immediately after each procedure using an adapted assessment form based on the Italian version of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ-I). Discomfort severity was graded across 10 predefined anatomical regions using a 5-point ordinal scale. Continuous variables were summarized as mean ± standard deviation, and exploratory associations between discomfort scores and operative variables were assessed using Spearman’s rank correlation coefficient and the Mann–Whitney U test. Results: Musculoskeletal discomfort was frequently reported across multiple anatomical regions. The neck was the most affected site (3.7 ± 0.9), with at least moderate symptoms in 83.3% of procedures, followed by the lower back (3.5 ± 1.1; 73.8%) and shoulders (3.3 ± 0.8; 71.4%). Wrist/hand discomfort was also common (3.1 ± 0.8; 61.9%). Procedure duration was positively correlated with lower back (ρ = 0.54, p < 0.001) and neck discomfort (ρ = 0.46, p = 0.002), while fluoroscopy time correlated with wrist/hand discomfort (ρ = 0.48, p = 0.001). Procedures exceeding 90 min were associated with higher lower back discomfort (p < 0.001). Conclusions: RIRS is associated with frequent surgeon musculoskeletal discomfort, predominantly affecting axial regions, supporting the need for ergonomic optimization in clinical practice.