MP05-19 WHAT IRRIGATION PRESSURES ARE SAFE? QUANTITATIVE ANALYSIS OF PYELOVENOUS BACKFLOW AT VARIOUS PRESSURES IN A PORCINE MODEL

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP05-19 WHAT IRRIGATION PRESSURES ARE SAFE? QUANTITATIVE ANALYSIS OF PYELOVENOUS BACKFLOW AT VARIOUS PRESSURES IN A PORCINE MODEL Anne Hong, Greg Jack, and Damien Bolton Anne HongAnne Hong More articles by this author , Greg JackGreg Jack More articles by this author , and Damien BoltonDamien Bolton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003216.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Irrigation fluid is required for visualization during ureteroscopy and pyeloscopy. Pressurized irrigation can result in pyelovenous backflow of irrigation into the vascular system providing a mechanism for urosepsis. We aim to quantify the amount of irrigation substrate that is absorbed via pyelovenous backflow at various pressures. METHODS: 6 deceased donor porcine kidneys were flushed with 1 L heparinized saline and preserved on ice using a renal transplant protocol. The renal artery was cannulated with a 10Fr catheter and perfused continuously with 0.9% normal saline solution (pH 6.77) at mean arterial pressure of 90 mmHg to simulate arterial blood flow. A steady state of venous effluent from the renal vein was achieved and collected continuously from the renal vein for the duration of the study. The ureter was cannulated with a 10Fr dual lumen ureteric catheter and the tip placed at the ureteropelvic junction and fixed in place with silk ties around the ureter. A pressure monitor (Comet II Pressure Guidewire®, Boston Scientific Corporation, Massachusetts, United States) was inserted through one lumen and positioned in the renal pelvis for continuous renal pelvis irrigation pressure monitoring. Distilled white vinegar (8% acetic acid, pH 3.32) was infused under pressure through the ureteral access catheter at various renal pelvic pressures (RPPs) to replicate pyeloscopy irrigation. RPP was increased in 15mmHg increments every 3 minutes and the venous effluent was collected at each increment. A control arm was conducted using RPP fixed at 30 mmHg for the duration of the 1 hour study with the venous effluent collected in the same 3 minute intervals. Statistical comparisons were performed using Wilcoxon rank test to compare the 15 mmHg increments. RESULTS: Figure 1 show venous pH following simulated ureteroscopy with 8% acetic acid at increasing RPP. Wilcoxon rank test demonstrated that from 90 mmHg onwards, the changes in pH were statistically significant. CONCLUSIONS: Ureteral irrigation fluids are initially detected in the renal venous effluent in trace amounts when renal pelvis irrigation pressures exceed 60 mmHg, and are statistically significant when RPP exceeds 90 mmHg. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e51 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Hong More articles by this author Greg Jack More articles by this author Damien Bolton More articles by this author Expand All Advertisement PDF downloadLoading ...