Development and Testing of an Anatomic in vitro Kidney Model for Measuring Intrapelvic Pressure During Ureteroscopy

Abstract

ObjectivesTo create an in vitro anatomic bench model that can mimic in vivo intrapelvic pressure (IPP) during ureteroscopy (URS) and compare it against existing in vivo and ex vivo data. MethodsA silicone kidney model (Simagine Health) that permits intrarenal endoscopic navigation was engineered to have a fluid-tight seal for the ureteral opening and a Tuohy-Borst valve in the renal pelvis incorporating a 0.2 mm pressure sensor (Opsens). To calibrate the model, a Cobra ureteroscope (Wolf) was inserted to the pelvis with 200cmH2O irrigation, and the valve adjusted until an IPP of 54cmH2O was obtained (prior human data). All experiments were conducted with a laser fiber in the working channel, with and without ureteral access sheaths (UAS) (11/13F, 13/15F) at irrigation setting of 61, 102, 153, and 193cmH2O using an automated system (Rocamed). Study outcome was mean steady-state IPP for each UAS/irrigation condition. ResultsFluid leakage through the Tuohy-Borst valve, which could be adjusted, was critical to simulate ureteric outflow during URS. IPP values for each condition corresponded with data from in vivo and ex vivo models. In the no UAS condition, IPP increased with increasing irrigation pressures, and surpassed 40cmH2O when ≥153cmH2O. When using a UAS, IPP was below 40cmH2O for all irrigation pressures. ConclusionsAn in vitro kidney model can simulate in vivo and ex vivo IPP profiles, and be tailored to different conditions by controlling fluid outflow. This bench model can be useful for testing of new technologies and their impact on IPP.