A study on the application of operating room nurse-led irrigation-fluid safety management in transurethral ureteropyelolithotomy surgery

This study aimed to evaluate the clinical application effect of the operating room nurse-coordinated irrigation-fluid safety management protocol in transurethral ureteropyelolithotomy (URS). A single-center retrospective cohort study design was adopted. The implementation date of the protocol, January 1, 2024, was used as the cutoff point. A total of 173 patients who underwent URS from June 2023 to June 2025 were divided into 2 groups: a control group (n = 85, conventional management) and an intervention group (n = 88, standardized irrigation-fluid safety management). Baseline data, irrigation fluid management process indicators (intrarenal pelvic pressure, temperature compliance rate, and early warning execution), postoperative complications (infection-related and hyponatremia), surgical efficiency (operative time and irrigation fluid volume), and postoperative recovery (length of hospital stay) were compared between the 2 groups. No statistically significant differences were observed in the measured baseline characteristics (all P > .05), although residual and unmeasured confounding cannot be excluded. Compared with the historical control cohort, the postimplementation cohort had lower recorded irrigation-system pressure values (24.0 [20.0, 28.0] vs 42.5 [35.0, 50.0] mm Hg, P < .001) and shorter documented above-threshold exposure (5.0 [2.0, 10.0] minutes vs prolonged exposure during the procedure, P < .001). The postimplementation cohort also had lower incidences of postoperative high fever (>38.5°C) (4.5% vs 14.1%, P = .027) and hyponatremia (2.3% vs 10.6%, P = .027), shorter operative time (55.0 [45.0, 70.0] vs 65.0 [50.0, 85.0] minutes, P = .004], lower irrigation fluid volume and estimated absorption volume (15.0 [12.0, 20.0] vs 18.5 [15.0, 25.0] L, P < .001; 150 [50, 300] vs 450 [200, 850] mL, P < .001), and shorter postoperative hospital stay (3.0 [2.0, 4.0] vs 4.0 [3.0, 5.0] days, P < .001). These findings represent associations in a nonrandomized before- and after-comparison. The operating room nurse-coordinated irrigation-fluid safety management protocol can effectively reduce intrarenal pelvic pressure and irrigation fluid absorption during URS, thereby significantly reducing the risk of postoperative infection and hyponatremia, while improving surgical efficiency and promoting postoperative recovery. It is worthy of clinical promotion and application.