Fluid Dynamic Analysis of Hand-Pump Infuser and UROMAT Endoscopic Automatic System for Irrigation Through a Flexible Ureteroscope.

Abstract

To evaluate the flow characteristics produced by a manual and automated-pump irrigation system connected to a flexible ureteroscope. An in vitro analysis of a manual hand-pump infuser (HP) and the UROMAT Endoscopic Automatic System for Irrigation® (E.A.S.I.) pump was performed. Standard irrigation tubing was used to connect a three-way valve to a flexible ureteroscope, the irrigation system, and a digital manometer. Flow rate and irrigation pressure measurements were recorded over a 15-minute period using pressure settings of 150 and 200 mm Hg for both irrigation pump systems. Once the HP was inflated to the initial pressure, it was not reinflated over the course of the trial. Data were collected with the working channel unoccupied and with placement of a 200 μm (0.6F) holmium laser fiber, 1.7F nitinol stone retrieval basket, or 2.67F guidewire. The difference in pressure measured at the site of inflow of irrigation to the ureteroscope was significantly greater using the HP compared to the E.A.S.I. pump at pressure settings of 150 mm Hg with and without the use of ureteroscopic instrumentation (p < 0.001), and at 200 mm Hg with instrumentation in the working channel (p < 0.01). There was no significant difference in the flow rate of irrigation through the open-channel ureteroscope over the course of 5 minutes between the two pump systems. The flow rates of irrigation produced by the HP and the E.A.S.I. pump are similar at pressures of 150 and 200 mm Hg irrespective of the occupancy of a ureteroscope's working channel during the first 5-minutes of irrigation. Irrigation pressure at the entry site of the ureteroscope is subject to significant variability with use of the HP compared to the E.A.S.I. pump irrigation system.