PD30-08 DOES FORCED IRRIGATION BUFFER HEAT GENERATED FROM HIGH-POWER LASER ACTIVATION DURING RETROGRADE INTRARENAL SURGERY

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INTRODUCTION AND OBJECTIVE: To check the effect of forced irrigation on the maximal temperature (Tmax) generated in the pelvicalyceal system from high-power laser activation during retrograde intrarenal surgery (RIRS) METHODS: After approval from veterinary service, a 30 kg female-pig was used for this study. The pig was put in supine orientation for general anesthesia, cystoscopy, and insertion of two sensor guidewires in both ureteral orifices to the pelvicalyceal system under fluoroscopic guidance. Retrograde pyelography and a superstiff guidewires were inserted in each ureter using dual-lumen ureteral catheter. The position was then turned to prone and a percutaneous access was obtained to fix a K-type thermocouple connected to a laptop for real-time recording of temperature during laser activation. The laser fiber (200µm) was introduced through the flexible ureteroscope (Kar Storz, Germany) and activated in the center of the calyx for 20, 40 and 60 seconds under gravity irrigation while the bag at 1meter from the table and forced irritation using a standard pump (Ureteroscopy Irrigation System, COOK Medical, Cook Ireland Ltd., Limerick, Ireland) at a power of 40W and 60W from the Lumenis Pulse P120H holmium laser system. The Tmax was recorded with the use of flexible URS without UAS, UAS 10/12, UAS 12/14, and UAS 14/16. RESULTS: Under gravity irrigation: during FURS without UAS, the Tmax was 75°C and 80 °C at 40W, and 60W respectively; during FURS with UAS 10-12, the Tmax was 70 °C, 74 °C at 40W, and 60W respectively; during FURS with UAS 12-14, the Tmax was 61.5 °C and 80 °C at 40W and 60W respectively; during FURS with UAS 14-16, the Tmax was 70 °C and 74 °C at 40W, and 60W respectively (Table 1). Under forced irrigation: during FURS without UAS, the Tmax was 41°C and 42 °C at 40W, and 60W respectively; during FURS with UAS 10-12, the Tmax was 39.9 °C, 41.6 °C at 40W, and 60W respectively; during FURS with UAS 12-14, the Tmax was 36.7 °C and 44.3 °C at 40W and 60W respectively; during FURS with UAS 14-16, the Tmax was 37.2°C and 37°C at 40W, and 60W respectively (Table 1). CONCLUSIONS: Despite the high-power laser, the Tmax could be kept within limits with the use of forced irrigation. However, the effect of forced irrigation on the intra-renal pressure should be kept in mindSource of Funding: This study was partially funded by a one-year scholarship from the European Urological Scholarship Program (EUSP) to Dr. Yasser Noureldin