Impact of the 2024 national medical fluid shortage on urologic practice in the United States: a cross-sectional survey.

OBJECTIVES: In September 2024, Hurricane Helene caused extensive infrastructure damage in the United States, including severe disruption to a major Baxter sterile irrigation fluid manufacturing facility in North Carolina, leading to a nationwide shortage of sterile irrigation fluids used in surgical procedures. The objective of this study was to evaluate the impact of the nationwide sterile irrigation fluid shortage on urologic practice across the United States (U.S.). METHODS: A descriptive, cross-sectional Research Electronic Data Capture (REDCap) survey was distributed to U.S. urologists. The questionnaire captured provider demographics, procedure delays, and practice/procedure modifications. RESULTS: Ninety-five surgeons responded. Overall, 76.8% reported an impact on practice, and 47% were directed by hospitals to cancel or reschedule cases. Over one-third rescheduled more than 10 procedures, with a median delay of two months. Benign prostatic hyperplasia (BPH) treatments and percutaneous nephrolithotomy (PCNL) were the most affected. About 36% noted a negative impact on physician-patient relationships. Nearly half (45.7%) modified outpatient procedures, primarily cystoscopies, using syringe irrigation or requesting patients arrive with full bladders. RESULTS: Surgical adjustments (40.4%) included switching from holmium laser enucleation of the prostate (HoLEP) to simple prostatectomy and reducing resident involvement. Postoperatively, increased catheter traction was used to limit irrigation. Twenty-nine urologists planned to retain conservation measures such as smaller fluid bags or reduced pressurized irrigation. At survey completion, 32.6% still experienced effects of the fluid shortage. CONCLUSIONS: The 2024 national fluid shortage significantly disrupted U.S. urology practice, especially endourology cases. Urologists adopted a range of clinical and surgical strategies, some of which may persist, underscoring the need for systemic preparedness to mitigate future shortages.