The eye of the endourologist: what are the risks? A review of the literature



During endourological procedures, the eye of the urologist is exposed to hazards such as contact with body fluids and irrigation solutions as well as laser injury, and X-ray radiation absorption. The resulting potential injuries and damages to the eye have not been summarily reviewed to date. The objective was to review the different risks of exposure to the eyes of urologists during endourological procedures.


The Medline database was searched for identification of studies on hazards to the eye of the endourologist. All articles published in English until September 2018 were considered.


Twenty-three publications were included in this analysis. The incidence of eye contact with patient body fluids or irrigation solutions during endoscopic procedures ranged between 37.50 and 100%. Laser-induced eye injuries were reported in 37.9% of all kind of adverse events related to laser use in urology. The eye lens dose of radiation ranged from 0.04 to 1600 µSv per endourological procedures.


While the risks of infection, laser injury, lens opacity and cataract are generally low, the wear of protective glasses is recommended. Lead glasses may protect against all these risks in case of Ho:YAG laser use with concomitant X-ray radiation. If Ho:YAG laser is used without any concomitant X-ray radiation, proper laser safety glasses or at least conventional eyeglasses should be recommended. When other types of laser are used, we recommend wearing laser eye protection glasses covering the adequate range of wavelength. For endourological procedures without laser use and X-ray radiation, specific protection devices such as goggles or face shields are recommended.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Bozzini PH (1806) Lichtleiter, eine Erfindung zur Anschauung innerer Teile und Krankheiten. J Prak Heilkd 24:107

    Google Scholar 

  2. 2.

    Desormeaux AJ (1867) The endoscope and its application to the diagnosis and treatment of affections of the genitourinary passages. Chicago Med J 24:177–194

    Google Scholar 

  3. 3.

    Shah J (2002) Endoscopy through the ages. BJU Int 89(7):645–652

    PubMed  Article  Google Scholar 

  4. 4.

    Samplaski MK, Jones JS (2009) Two centuries of cystoscopy: the development of imaging, instrumentation and synergistic technologies. BJU Int 13(2):154–158

    Article  Google Scholar 

  5. 5.

    Linder TE, Simmen D, Stool SE (1997) Revolutionary inventions in the 20th century. The history of endoscopy. Arch Otolaryngol Head Neck Surg. 123(11):1161–1163

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Hubosky SG, Healy KA, Grasso M, Bagley DH (2014) Accessing the difficult ureter and the importance of ureteroscope miniaturization: history is repeating itself. Urology 84(4):740–742

    PubMed  Article  Google Scholar 

  7. 7.

    Faul P (1993) Video TUR: raising the gold standard. Eur Urol 24:256–261

    CAS  PubMed  Article  Google Scholar 

  8. 8.

    Stein BS, Kendall AR (1984) Lasers in urology. I. Laser physics and safety. Urology 23(5):405–410

    CAS  PubMed  Article  Google Scholar 

  9. 9.

    Johnson DE, Cromeens DM, Price RE (1992) Use of the holmium:YAG laser in urology. Lasers Surg Med 12(4):353–363

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Falagas ME, Pitsouni EI, Malietzis GA, Pappas G (2008) Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. FASEB J 22(2):338–342

    CAS  PubMed  Article  Google Scholar 

  11. 11.

    McNicholas TA, Jones DJ, Sibley GN (1989) AIDS: the contamination risk in urological surgery. Br J Urol 63(6):565–568

    CAS  PubMed  Article  Google Scholar 

  12. 12.

    Kapoor DA, Smiley DG, Reddy PK (1993) The risk of exposure to potentially contaminated body fluids in urological surgery. J Urol 149(5):1058–1060

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Wines MP, Lamb A, Argyropoulos AN, Caviezel A, Gannicliffe C, Tolley D (2008) Blood splash injury: an underestimated risk in endourology. J Endourol 22(6):1183–1187

    PubMed  Article  Google Scholar 

  14. 14.

    Davies JH, Harrison GS (1991) Should urologists wear spectacles for transurethral resection of the prostate? Br J Urol 67(2):182–183

    CAS  PubMed  Article  Google Scholar 

  15. 15.

    Muir GH, Davies JH (1996) Video-resection does not stop corneal contamination during transurethral resection of the prostate. Br J Urol 77(6):836–838

    CAS  PubMed  Article  Google Scholar 

  16. 16.

    Taylor JD (1990) AIDS and hepatitis B and C: contamination risk at transurethral resection. A study using sodium fluorescein as a marker. Med J Aust 153(5):257–260

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Staehler G, Hofstetter A, Gorisch W, Keiditsch E, Müssiggang M (1976) Endoscopy in experimental urology using an argon-laser beam. Endoscopy 8(1):1–4

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Althunayan AM, Elkoushy MA, Elhilali MM, Andonian S (2014) Adverse events resulting from lasers used in urology. J Endourol 28(2):256–260

    PubMed  Article  Google Scholar 

  19. 19.

    Villa L, Cloutier J, Compérat E, Kronemberg P, Charlotte F, Berthe L, Rouchausse Y, Salonia A, Montorsi F, Traxer O (2016) Do we really need to wear proper eye protection when using Holmium:YAG laser during endourologic procedures? Results from an ex vivo animal model on pig eyes. J Endourol 30(3):332–337

    PubMed  Article  Google Scholar 

  20. 20.

    Authors on behalf of ICRP, Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs–threshold doses for tissue reactions in a radiation protection context. Ann ICRP. 41(1–2):1–322

    Google Scholar 

  21. 21.

    Rao PN, Faulkner K, Sweeney JK, Asbury DL, Sambrook P, Blacklock NJ (1987) Radiation dose to patient and staff during percutaneous nephrostolithotomy. Br J Urol 59(6):508–512

    CAS  PubMed  Article  Google Scholar 

  22. 22.

    Bowsher WG, Blott P, Whitfield HN (1992) Radiation protection in percutaneous renal surgery. Br J Urol 69(3):231–233

    CAS  PubMed  Article  Google Scholar 

  23. 23.

    Hellawell GO, Mutch SJ, Thevendran G, Wells E, Morgan RJ (2005) Radiation exposure and the urologist: what are the risks? J Urol 174(3):948–952

    CAS  PubMed  Article  Google Scholar 

  24. 24.

    Safak M, Olgar T, Bor D, Berkmen G, Gogus C (2009) Radiation doses of patients and urologists during percutaneous nephrolithotomy. J Radiol Prot 29(3):409–415

    CAS  PubMed  Article  Google Scholar 

  25. 25.

    Majidpour HS (2010) Risk of radiation exposure during PCNL. Urol J 7(2):87–89

    PubMed  Google Scholar 

  26. 26.

    Ritter M, Krombach P, Martinschek A, Siegel FP, Schmitt M, Weiss C, Häcker A, Pelzer AE (2012) Radiation exposure during endourologic procedures using over-the-table fluoroscopy sources. Endourology 26(1):47–51

    Article  Google Scholar 

  27. 27.

    Taylor ER, Kramer B, Frye TP, Wang S, Schwartz BF, Köhler TS (2013) Ocular radiation exposure in modern urological practice. J Urol 190(1):139–143

    PubMed  Article  Google Scholar 

  28. 28.

    Hristova-Popova J, Zagorska A, Saltirov I, Petkova K, Vassileva J (2015) Risk of radiation exposure to medical staff involved in interventional endourology. Radiat Prot Dosim 165(1–4):268–271

    CAS  Article  Google Scholar 

  29. 29.

    Vano E, Fernandez JM, Resel LE, Moreno J, Sanchez RM (2016) Staff lens doses in interventional urology. A comparison with interventional radiology, cardiology and vascular surgery values. J Radiol Prot 36(1):37–48

    CAS  PubMed  Article  Google Scholar 

  30. 30.

    Galonnier F, Traxer O, Rosec M, Terrasa JB, Gouezel P, Celier D, Bassinet C, Ruffion A, Paparel P, Fiard G, Terrier JE (2016) Surgical staff radiation protection during fluoroscopy-guided urologic interventions. J Endourol 30(6):638–643

    PubMed  Article  Google Scholar 

  31. 31.

    Medici S, Pitzschke A, Cherbuin N, Boldini M, Sans-Merce M, Damet J (2017) Eye lens radiation exposure of the medical staff performing interventional urology procedures with an over-couch X-ray tube. Phys Med 43:140–147

    CAS  PubMed  Article  Google Scholar 

  32. 32.

    Hartmann J, Distler F, Baumüller M, Guni E, Pahernik S, Wucherer M (2018) Risk of radiation-induced cataracts: investigation of radiation exposure to the eye lens during endourologic procedures. J Endourol 32(10):897–903

    PubMed  Article  Google Scholar 

  33. 33.

    Horsburgh BA, Higgins M (2016) A study of occupational radiation dosimetry during fluoroscopically guided simulated urological surgery in the lithotomy position. J Endourol 30(12):1312–1320

    PubMed  Article  Google Scholar 

  34. 34.

    Harris AM (2018) Radiation exposure to the urologist using an overcouch radiation source compared with an undercouch radiation source in contemporary urology practice. Urology 114:45–48

    PubMed  Article  Google Scholar 

  35. 35.

    Dudley AG, Semins MJ (2015) Radiation practice patterns and exposure in the high-volume endourologist. Urology 85(5):1019–1024

    PubMed  Article  Google Scholar 

  36. 36.

    Gioannini P, Sinicco A, Cariti G, Lucchini A, Paggi G, Giachino O (1988) HIV infection acquired by a nurse. Eur J Epidemiol 4(1):119–120

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Cimino T, Neirotti S (1988) Risk of HIV infection in health personnel involved in tasks of assistance, diagnosis and treatment. Description of 2 cases: one, of ascertained infection, the other under observation. Minerva Med 79(9):799–804

    CAS  PubMed  Google Scholar 

  38. 38.

    Sartori M, La Terra G, Aglietta M, Manzin A, Navino C, Verzetti G (1993) Transmission of hepatitis C via blood splash into conjunctiva. Scand J Infect Dis 25(2):270–271

    CAS  PubMed  Article  Google Scholar 

  39. 39.

    Rosen HR (1997) Acquisition of hepatitis C by a conjunctival splash. Am J Infect Control 25(3):242–247

    CAS  PubMed  Article  Google Scholar 

  40. 40.

    Hosoglu S, Celen MK, Akalin S, Geyik MF, Soyoral Y, Kara IH (2003) Transmission of hepatitis C by blood splash into conjunctiva in a nurse. Am J Infect Control 31(8):502–504

    PubMed  Article  Google Scholar 

  41. 41.

    Chong SJ, Smith C, Bialostocki A, McEwan CN (2007) Do modern spectacles endanger surgeons? The Waikato Eye Protection Study. Ann Surg 245(3):495–501

    PubMed  PubMed Central  Article  Google Scholar 

  42. 42.

    Paterson NR, Fitzpatrick R, Blew B, Denstedt J, Watterson J (2018) Perceptions and practice patterns of holmium laser goggles in endourological procedures: an unnecessary evil? J Endourol.

    Article  PubMed  Google Scholar 

  43. 43.

    Jaco JW, Miller DL (2010) Measuring and monitoring radiation dose during fluoroscopically guided procedures. Tech Vasc Interv Radiol 13(3):188–193

    PubMed  Article  Google Scholar 

  44. 44.

    Richman AH, Chan B, Katz M (1976) Effectiveness of lead lenses in reducing radiation exposure. Radiology 121(2):357–359

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Agarwal SK, Friesen EJ, Huddleston AL, Rao RP (1978) The effectiveness of glass lenses in reducing exposure to the eyes. Radiology 129(3):810–811

    CAS  PubMed  Article  Google Scholar 

Download references

Author information




SD: Protocol development, data collection and management, data analysis, manuscript writing/editing. MA: Data collection and management, data analysis, manuscript editing. LV: Data analysis, manuscript editing. MR-MH: Data analysis, manuscript editing. VDC: Data analysis, manuscript editing. EXK: Data analysis, manuscript editing. OT: Project development, data analysis, manuscript editing.

Corresponding author

Correspondence to Olivier Traxer.

Ethics declarations

Conflict of interest

Prof. Olivier Traxer is a consultant for Coloplast, Rocamed, Olympus, EMS, Boston Scientific and IPG Medical. Dr. Steeve Doizi is a consultant for Boston Scientific and Coloplast. Dr. Marie Audouin, Luca Villa, Maria Rodríguez-Monsalve Herrero, Vincent De Coninck, Etienne Xavier Keller have no relevant conflict of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

No informed consents were necessary for this study, since no research directly involving human participants and/or animals was performed in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Doizi, S., Audouin, M., Villa, L. et al. The eye of the endourologist: what are the risks? A review of the literature. World J Urol 37, 2639–2647 (2019).

Download citation


  • Endourology
  • Urology
  • Eye
  • Injury
  • Laser
  • Percutaneous nephrolithotomy
  • Radiation
  • Transurethral resection
  • Ureteroscopy