MP15-10 MANUAL PRESSURE IRRIGATION AT FLEXIBLE URETERORENOSCOPY IS ASSOCIATED WITH INCREASED PAIN AND READMISSION

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy III (MP15)1 Apr 2020MP15-10 MANUAL PRESSURE IRRIGATION AT FLEXIBLE URETERORENOSCOPY IS ASSOCIATED WITH INCREASED PAIN AND READMISSION Matthew Farag*, Gregory Jack, Catriona Duncan, Nathan Lawrentchuck, and Damien Bolton Matthew Farag*Matthew Farag* More articles by this author , Gregory JackGregory Jack More articles by this author , Catriona DuncanCatriona Duncan More articles by this author , Nathan LawrentchuckNathan Lawrentchuck More articles by this author , and Damien BoltonDamien Bolton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000840.010AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pressured irrigation is routinely utilised in treatment of urinary calculi by uretero-renoscopic surgery. Although this can be in multiple forms, standardised pneumatic pressure upon the fluid irrigation bag is the routine. Another method is the use of similar fluid under pressure with routine intermittent manual pressure on a refillable chamber, which is suggested to provide improved vision during those periods when the hydrostatic pressure is increased. There is little data to suggest preferential outcomes from either format, and consequently the technique utilised tends to be at the discretion of the surgeon. We aimed to evaluate the outcomes of treatment for those patients from our institution who were treated using both of these forms of pressured irrigation. METHODS: Patients were allocated to the operating lists of a group of endourologists at a large teaching hospital by a bookings officer who had no knowledge of which surgeon would routinely use manually pressured irrigation intermittently throughout a period of standard pressured irrigation. There was no stratification of patients to different urologists based upon stone size, location, composition or patient demographics. Stone specific data was recorded in an established database, and outcomes of treatment were identified by an independent researcher who was not one of the treating urologists. RESULTS: 173 patients were treated by flexible ureterorenoscopic stone laser over a 2 year period. Mean patient age was 54 years and 111 patients (64%) were male. 149 (86%) of patients had renal stones and the remainder had proximal ureteric stones. 10 patients had staghorn renal calculi who were treated without percutaneous access. Median stone size was identical (10.0 mm) between the two groups who were treated with and without manually pressured irrigation. Retreatment rate was similar at 17% in each cohort. There was no difference in the inpatient length of stay (1.16 vs 1.14 days), although episodes of hypotension and tachycardia post surgery requiring medical review were more common in the group treated with manually pressured irrigation (29 patients vs 2 patients Chi2 p = 0.04). There was no difference in post operative rates of urinary tract infection. Time spent undertaking ureteroscopic stone laser and retrieval was significantly increased in the group who underwent treatment with additional manually pressured irrigation (98.4 vs 81.3 minutes). Representation rates of patients to the emergency department within 60 days were considerably increased in patients who had undergone treatment with routine use of intermittent manually pressured irrigation (44 patients vs 5 patients Chi2 p = 0.04), and the main cause of increased representation was flank pain (37 patients vs 1 Chi2 p = 0.003). CONCLUSIONS: Routine use of intermittent manually pressured irrigation in addition to background hydrostatic pressure irrigation does not appear to confer any objective benefit in regard to outcomes of stone treatment. Although there may be an anecdotal and temporary benefit in regard to vision during ureterorenoscopy this technique appears to be associated with a significantly greater readmission rate after surgery, and an increased risk of hypotension and tachycardia post surgery. It is hard to justify the routine use of this operative technique, which should be reserved for specific instances where routine techniques are proving inadequate for endoscopic management of upper tract calculi. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e208-e208 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Farag* More articles by this author Gregory Jack More articles by this author Catriona Duncan More articles by this author Nathan Lawrentchuck More articles by this author Damien Bolton More articles by this author Expand All Advertisement PDF downloadLoading ...