MP44-07 RELATIONSHIP BETWEEN RENAL PELVIS PRESSURE AND POST-URETEROSCOPY INFECTION IN A LIVE SWINE MODEL

Abstract

You have accessJournal of UrologyCME1 May 2022MP44-07 RELATIONSHIP BETWEEN RENAL PELVIS PRESSURE AND POST-URETEROSCOPY INFECTION IN A LIVE SWINE MODEL David Hinojosa-Gonzalez, Christina Kottooran, Jennifer Saunders, Marle Franco, and Brian Eisner David Hinojosa-GonzalezDavid Hinojosa-Gonzalez More articles by this author , Christina KottooranChristina Kottooran More articles by this author , Jennifer SaundersJennifer Saunders More articles by this author , Marle FrancoMarle Franco More articles by this author , and Brian EisnerBrian Eisner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urosepsis is reported to occur after 5% of ureteroscopic stone procedures; rates of pyelonephritis are higher. In this study, a live swine model was used to evaluate the relationship between renal pelvis pressure and infection after ureteroscopy. METHODS: In anesthetized pigs (n=13; female; ∼60 kg each), ureteroscopy was performed as follows: cystoscopy was performed to position a 0.014” pressure sensor guidewire (Comet™, Boston Scientific, Marlborough, MA) in the renal pelvis. A flexible ureteroscope was then introduced into the renal pelvis and the position of the ureteroscope and the pressure sensor wire were confirmed. Infusion of saline irrigation fluid alone or with a standardized concentration of uropathogenic e. coli strain CFT073 (1.5 x 107 CFU/ml) at target renal pelvic pressures (37 mm Hg and 75 mm Hg) was maintained for 60 minutes using a pressure bag and instantaneous feedback from the pressure-sensing guidewire. Venous blood sampling was performed during the procedure as well as at 1, 3,6, 12, and 24 hours after surgery. Vital signs were monitored, inflammatory biomarkers were assayed, and renal tissue and blood cultures were obtained. RESULTS: Thirteen (13) pig kidneys were used during the study and study groups were as follows: 37 mm Hg with saline irrigation (n=3), 75 mm Hg with saline irrigation (n=3), 37 mm Hg with saline irrigation with 1.5 x 107 CFU/ml e. coli added (n=3), and 75 mm Hg with saline irrigation with 1.5 x 107 CFU/ml e. coli added (n=4). Table 1 shows the results of the study: changes in inflammatory biomarkers were most pronounced in the 75 mm Hg saline irrigation + e. coli. All kidneys in both groups treated with saline + e. coli irrigation cultured positive for bacteria but interestingly, bacteremia was seen in 0/4 animals treated at 37 mm Hg with saline + e. coli irrigation and 4/4 animals treated at 75 mm Hg with saline + e. coli irrigation. CONCLUSIONS: In this study of a swine model of ureteroscopy, irrigation with saline + e. coli produced an inflammatory response as well as positive kidney cultures (i.e. pyelonephritis). However, bacteremia was only seen in animals treated at 75 mmHg. These data suggest that there may be a renal pelvis pressure threshold above which it is more likely that animals with infected urine may develop post-ureteroscopy bacteremia. Source of Funding: Boston Scientific Corporation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e754 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Hinojosa-Gonzalez More articles by this author Christina Kottooran More articles by this author Jennifer Saunders More articles by this author Marle Franco More articles by this author Brian Eisner More articles by this author Expand All Advertisement PDF DownloadLoading ...