PD23-02 IN VITRO STUDY OF INTRA-RENAL PRESSURE (IRP) WITH SINGLE-USE DISPOSABLE FLEXIBLE URETERO-RENOSCOPES (D-FUR), URETERAL ACCESS SHEATH (UAS) COMBINATIONS AND DEPLOYED WORK CHANNEL (WC) ACCESSORIES

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (PD23)1 Apr 2020PD23-02 IN VITRO STUDY OF INTRA-RENAL PRESSURE (IRP) WITH SINGLE-USE DISPOSABLE FLEXIBLE URETERO-RENOSCOPES (D-FUR), URETERAL ACCESS SHEATH (UAS) COMBINATIONS AND DEPLOYED WORK CHANNEL (WC) ACCESSORIES Anup Patel*, Alper Rezzak Aydin, Remzi Saglam, Nida Zafer Tokatli, Kemal Sarica, and Ahmet Sinan Kabakci Anup Patel*Anup Patel* More articles by this author , Alper Rezzak AydinAlper Rezzak Aydin More articles by this author , Remzi SaglamRemzi Saglam More articles by this author , Nida Zafer TokatliNida Zafer Tokatli More articles by this author , Kemal SaricaKemal Sarica More articles by this author , and Ahmet Sinan KabakciAhmet Sinan Kabakci More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000873.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Background: Single use D-FUR have gained a foothold in contemporary clinical practice with key opinion leaders recommending their routine use in low volume centers and for complex RIRS cases which may risk damage to re-usable equivalents Objective: To evaluate effects of 2 market-leading D-FUR were placed inside 6 UAS (9.5-12Fr lumen), and 4 WC deployed accessory combinations, on inflow flow rates (IFR) and IRP. METHODS: Design: New-unused accessories, UAS and disposable FUR shafts (BSC Lithovue and Pusen PU3022) were measured with micrometers (Mitutoyo and Insize, UK) to contrast with manufacturer’s labels. All combinations were studied in vitro using the Minnesota University kidney model fitted with a 5Fr nephrostomy tube, connected to a urodynamic pressure transducer (MMS, Netherlands). Variables: IFR was gravity (60, 80 and 100cm) and pump controlled (5-40ml/min – Elmed, Turkey). Commonly available FUR with a free and occupied (200 + 270mm laser fibers; 1.9 + 2.2Fr baskets) WC, were combined with 6 different commonly available UAS sizes. UAS tips were positioned in the model’s proximal ureter while FUR tips were positioned straight in the renal pelvis (RP) and then at 270° fixed deflection (lower calyx - LC). Outcome measures: Steady state IFR and IRP. High IRP was defined as >40cm/H2O. RESULTS: Results and Limitations: Measured D-FUR shaft size was 9.4 (Lithovue)-9.6Fr (Pusen) (manufacturers’ labels 9.5Fr). Neither D-FUR could be inserted into the 9.5-11.5Fr UAS and both yielded uniformly unsafe pressures in the Coloplast 10-12Fr (9.8-12Fr measured) UAS. Both D-FUR only yielded safe IRP in the 12-14Fr UAS (measured 11.9-14.1Fr) under all test conditions (with and without WC accessories) – measured SES>2.3Fr. For intermediate UAS sizes, only low pump inflow rates <15ml/min were safe along with an occupied work channel and gravity inflow of <80cm H2O due to smaller SES (0.5-1.2Fr for Pusen PU3022; 0.7-1.4Fr for BSC-Lithovue) There was no IRP change with maximal FUR fixed deflection. CONCLUSIONS: Due to their larger shaft diameter compared to many re-usable equivalents, market-leading D-FUR may be unsafe with regard to IRP levels for longer complex RIRS procedures, unless used in conjunction with a ureteral access sheath with a 12Fr (declared) lumen (or one at least >2Fr larger than measured scope diameter). This new finding may limit their safe primary use (without pre-stenting) in situations where less accommodating-compliant ureters are encountered. Source of Funding: No funding, MMS Urodynamics equipment (Laborie Solar) loan from Laborie dealer © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e464-e464 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anup Patel* More articles by this author Alper Rezzak Aydin More articles by this author Remzi Saglam More articles by this author Nida Zafer Tokatli More articles by this author Kemal Sarica More articles by this author Ahmet Sinan Kabakci More articles by this author Expand All Advertisement PDF downloadLoading ...