The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP-tool): a Delphi consensus project on standardised evaluation of flexible ureterorenoscopes

Michaël M. Henderickx, Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Nora Hendriks, Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Joyce Baard, Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Oliver J. Wiseman, Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Kymora B. Scotland, Department of Urology, University of California, Los Angeles, CA, USA.
Bhaskar K. Somani, Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK.
Tarik E. Şener, Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.
Esteban Emiliani, Department of Urology, Fundacio Puigvert, Barcelona, Spain.
Laurian B. Dragos, Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Luca Villa, Department of Urology, Università Vita - Salute San Raffaele, Milan, Italy.
Michele Talso, Department of Urology, ASST Fatebenefratelli Sacco - Ospedale Luigi Sacco University Hospital, Milan, Italy.
Saeed Bin Hamri, Department of Urology, King Abdullah International Medical Research Center, College of Medicine, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia.
Silvia Proietti, Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy.
Steeve Doizi, Department of Urology, Hopital Tenon, Paris, France.
Olivier Traxer, Department of Urology, Hopital Tenon, Paris, France.
Ben H. Chew, Department of Urology, University of British Columbia, Vancouver, BC, Canada.
Brian H. Eisner, Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
Manoj Monga, Department of Urology, University of California San Diego, San Diego, CA, USA.
Ryan S. Hsi, Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
Karen L. Stern, Department of Urology, Mayo Clinic, Phoenix, AZ, USA.
David A. Leavitt, Department of Urology, Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
Marcelino Rivera, Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
Daniel A. Wollin, Department of Urology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Michael Borofsky, Department of Urology, University of Minnesota, Minneapolis, MN, USA.
Noah E. Canvasser, Department of Urology, University of California Davis Health System, Sacramento, CA, USA.
Johann P. Ingimarsson, Department of Urology, Maine Medical Center, South Portland, ME, USA.
Marawan M. El Tayeb, Department of Urology, Baylor Scott & White Medical Center - Temple, Temple, TX, USA.
Naeem Bhojani, Department of Urology, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, QC, Canada.
Nariman Gadzhiev, Department of Urology, Endourology Academy, Istanbul, Turkey.
Thomas Tailly, Department of Urology, University Hospital Ghent, Ghent, Belgium.
Otas Durutovic, Department of Urology, University Clinical Center of Serbia, Belgrade, Serbia.
Udo Nagele, Department of Urology, General Hospital Hall I.T., Hall in Tirol, Austria.

Abstract

OBJECTIVE: To develop a standardised tool to evaluate flexible ureterorenoscopes (fURS). MATERIALS AND METHODS: A three-stage consensus building approach based on the modified Delphi technique was performed under guidance of a steering group. First, scope- and user-related parameters used to evaluate fURS were identified through a systematic scoping review. Then, the main categories and subcategories were defined, and the expert panel was selected. Finally, a two-step modified Delphi consensus project was conducted to firstly obtain consensus on the relevance and exact definition of each (sub)category necessary to evaluate fURS, and secondly on the evaluation method (setting, used tools and unit of outcome) of those (sub)categories. Consensus was reached at a predefined threshold of 80% high agreement. RESULTS: The panel consisted of 30 experts in the field of endourology. The first step of the modified Delphi consensus project consisted of two questionnaires with a response rate of 97% (n = 29) for both. Consensus was reached for the relevance and definition of six main categories and 12 subcategories. The second step consisted of three questionnaires (response rate of 90%, 97% and 100%, respectively). Consensus was reached on the method of measurement for all (sub)categories. CONCLUSION: This modified Delphi consensus project reached consensus on a standardised grading tool for the evaluation of fURS - The Uniform grading tooL for flexIble ureterorenoscoPes (TULIP) tool. This is a first step in creating uniformity in this field of research to facilitate future comparison of outcomes of the functionality and handling of fURS.