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

Michaël M.E.L. Henderickx, Nora Hendriks, Joyce Baard, Oliver J. Wiseman, Kymora B. Scotland, Bhaskar K. Somani, Tarik E. Şener, Esteban Emiliani, Laurian B. Dragos, Luca Villa, Michele Talso, Saeed Bin Hamri, Silvia Proietti, Steeve Doizi, Olivier Traxer, Ben H. Chew, Brian H. Eisner, Manoj Monga, Ryan S. Hsi, Karen L. SternDavid A. Leavitt, Marcelino Rivera, Daniel A. Wollin, Michael Borofsky, Noah E. Canvasser, Johann P. Ingimarsson, Marawan M. El Tayeb, Naeem Bhojani, Nariman Gadzhiev, Thomas Tailly, Otas Durutovic, Udo Nagele, Andreas Skolarikos, Barbara M.A. Schout, Harrie P. Beerlage, Rob C.M. Pelger, Guido M. Kamphuis

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)494-502
Number of pages9
JournalBJU International
Issue number4
StatePublished - Apr 2023

Bibliographical note

Funding Information:
We would like to thank the CoRE, EDGE, ESUT and PETRA working groups and their members for the participation in this modified Delphi consensus project. Furthermore, we would like to express our sincere gratitude towards our fellow PhD candidates Ben-Max de Ruiter, Luigi van Riel and Hilin Yildirim for reviewing the questionnaires.

Publisher Copyright:
© 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.


  • #EndoUrology
  • #UroStone
  • #Urology
  • Delphi consensus
  • endourology
  • evaluation
  • flexible ureterorenoscope
  • quality assessment
  • tool

PubMed: MeSH publication types

  • Systematic Review
  • Journal Article


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