PD37-03 DETERMINING THE THRESHOLD OF SAFETY FOR INTRARENAL PRESSURE DURING FLEXIBLE URETEROSCOPY USING AN IN VIVO PIG MODEL

Abstract

You have accessJournal of UrologyCME1 May 2022PD37-03 DETERMINING THE THRESHOLD OF SAFETY FOR INTRARENAL PRESSURE DURING FLEXIBLE URETEROSCOPY USING AN IN VIVO PIG MODEL Matthew Lee, Deepak Agarwal, Bret Connors, Mark Assmus, James Williams, Tim Large, and Amy Krambeck Matthew LeeMatthew Lee More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Bret ConnorsBret Connors More articles by this author , Mark AssmusMark Assmus More articles by this author , James WilliamsJames Williams More articles by this author , Tim LargeTim Large More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002595.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) is the most commonly performed surgery for kidney stones. Multiple studies have investigated what intrarenal pressures (IRPs) occur during URS. However, no one has attempted to identify a threshold for IRP, that if exceeded, will result in renal parenchymal damage. Herein, we attempted to identify this IRP safety threshold by subjecting in vivo porcine kidneys to various levels of pressurized irrigation. METHODS: 10 female pigs (60–80 kg) were intubated and sedated. The abdomen was opened with electrocautery and the ureters were isolated and opened. We inserted a LithoVue (Boston Scientific) ureteroscope into the ureter and advanced it up to the kidney. An 0-silk tie was then used to tie the ureter around the scope to create a closed system so we could subject the kidney to a maximum level of pressure. Realtime IRPs were measured using the Comet Pressure Wire (Boston Scientific). Kidneys were subjected to various levels of pressure (0, 50, 100, and 150 mmHg) for 36 minutes (based on published mean URS times). The control arm had 3 kidneys and each pressure group had 5 kidneys. Kidneys were then fixed using an intravascular perfusate and harvested. Two expert pathologists then independently analyzed kidney slides (H&E staining and picrosirius red) to identify areas of renal damage. RESULTS: The differences in mean IRPs between the groups was significant (p <0.0001). Two kidneys were exposed to IRPs >185 mmHg as we initially planned to have a 300 mHg group. We identified that IRPs greater than 185mmHg routinely resulted in forniceal rupture. Kidneys subjected to pressures >185 mmHg developed large areas of hematoma. We did not find any differences in renal parenchymal damage. CONCLUSIONS: No differences in renal parenchymal damage were identified between pressure groups of 50, 100, or 150 mmHg. However, IRPs >185 mmHg did result in forniceal rupture. Source of Funding: Boston Scientific © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e639 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Deepak Agarwal More articles by this author Bret Connors More articles by this author Mark Assmus More articles by this author James Williams More articles by this author Tim Large More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF DownloadLoading ...