Assessing Gaps Related to Ureter Imaging

  There is a low incidence rate of iatrogenic ureteral injury following abdominal surgery that consequently comes with a high risk of morbidity and mortality.  There are conventional inspection methods for ureter identification, including palpitation and visual inspection. To identify current methods of ureter assessment and establish needs, identify gaps in knowledge, levels of competence, and performance, and examine attitudes towards modalities in use, the researchers designed and conducted a study in both urban and rural settings. This  included multiple surgeons from appropriate specialties participating in the study.


Educational Strategy:

A mixed-methods qualitative/quantitative needs assessment of 794 surgeons from multiple specialties were conducted.  Researchers conducted a qualitative interview of nine surgeons, including four OB/GYN, three urologists, and two general surgeons.  A quantitative survey, disseminated electronically, was completed by 785 specialists.  Statistical and qualitative analysis was conducted.


Patient-Level Outcome(s) Measured:

Survey participants were an excellent range of provider ages, years’ experience, level of education, and location. Continuing medical education training activities are limited in ureteral imaging agents in all locations and settings, with the least amount of education focused on near-infrared fluorescent (NIRF) imaging agents. The majority of participants demonstrated the highest competency in conventional imaging agents. Rural providers demonstrated less than two (2) CME hours in all areas, with the exception of abdominal surgery complications. Random provider phone interviews validated these findings and correlated them to survey findings.

Conventional ureteral imaging agents are the preferred method with limited utilization of novel imaging agents. Education, training, and focused conferences to target direct specialists are needed to increase the use of novel methods.