Musculoskeletal Disorders Among Endourologists: A Review of Occupational Risk in Endourological Procedures

Objective: Work-related musculoskeletal disorders (WMSDs) are increasingly recognized among surgeons, yet their burden across the full spectrum of endourological practice has not been systematically characterized. This review aimed to assess the prevalence, anatomical distribution, and determinants of MSDs among endourologists. Evidence Acquisition: A preregistered protocol (PROSPERO: CRD420261394815) guided a systematic search of PubMed and EMBASE. Thirty studies met the inclusion criterion, encompassing surveys, prospective cohort studies, randomized controlled trials, surface electromyography studies, biomechanical experiments, and clinical registries. Quality was assessed using the Newcastle–Ottawa Scale and Cochrane RoB 2 tool. Heterogeneity in study design and outcome precluded formal meta-analysis, and a narrative synthesis was performed. Evidence Synthesis: WMSDs affect the majority of practicing endourologists, with prevalence estimates ranging from 32% to 86%. Endourology independently predicted chronic MSDs (odds ratio 3.06, 95% confidence interval 1.37–6.80). Flexible ureteroscopy (fURS) was associated with the highest anatomical burden, affecting the neck, shoulder, upper back, and hand–wrist complex; heavier reusable fiber-optic scopes generate significantly greater muscle activation than lighter single-use digital instruments. Percutaneous nephrolithotomy can result in substantial erector spinae loading, with prone positioning the most demanding configuration; heavy lithotripter handpieces received consistently poor ergonomic ratings. Transurethral endoscopy (transurethral resection of the prostate/bladder tumor) commonly causes trapezius fatigue in most procedures, with predicted muscular endurance time approximating operative duration; video-assisted monitor endoscopy halved fatigue incidence. Laser prostatectomy (holmium laser enucleation of the prostate) is associated with high neck and shoulder burden, compounded by gland size and operative duration. Several reports demonstrated that robotic fURS dramatically reduced ergonomic burden (total score 5.6 vs 31.3, p < 0.01). Conclusions: MSDs are a significant, under-addressed occupational hazard in endourology. Ergonomics deserve the same priority afforded to robotics in surgical innovation. Instrument redesign, ergonomic operating room configuration, structured training, and greater awareness, including within residency curricula, offer actionable mitigation. Prospective, standardized, multicenter research is urgently needed.