PD42-09 ENDOSCOPIC VALVES AND IRRIGATION DEVICES: A COMPARATIVE ANALYSIS

Abstract

You have accessJournal of UrologyStone Disease: New Technology1 Apr 2015PD42-09 ENDOSCOPIC VALVES AND IRRIGATION DEVICES: A COMPARATIVE ANALYSIS Sarah Tarplin, Michael Byrne, Manoj Monga, and Sri Sivalingam Sarah TarplinSarah Tarplin More articles by this author , Michael ByrneMichael Byrne More articles by this author , Manoj MongaManoj Monga More articles by this author , and Sri SivalingamSri Sivalingam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2594AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A variety of irrigation systems are available for ureteroscopy (URS), from gravity-driven pressure bags to hand-operated pumps. Endoscopic valves maintain a water-tight seal during URS, while facilitating the passage of instruments. The relative ergonomics of different devices have not been established. Our aim is to compare the mechanical properties and usability of valves and hand-operated irrigation systems in an in-vitro setting that models clinical use. METHODS Four endoscopic valves were tested in vitro: UroSeal Adjustable Endoscopic Valve (US Urology), Adjustable Biopsy Port Seal (Gyrus ACMI), Blue Silicone Seal CS B612 (Gyrus ACMI), and REF ABP Biopsy Port Seal (ACMI). Leak point pressure (LPP) was tested with a Viper Ureteroscope (Richard Wolf Endoscopy) and the Thermedx Fluid Management System (TFMS, Thermedx). Insertion and extraction forces of instruments through the devices were measured. Insertion time was assessed for: [(a straight tip Sensor wire, 0.035”, Boston Scientific), a laser fiber (Flexiva 200, Boston Scientific), and an Ngage Nitinol Stone Extractor 1.7Fr (Cook Urological)] through a flexible ureteroscope (Olympus URF P5, Olympus). Flow rate, flow time, and user fatigue were tested for two irrigation systems: the Single Action Pumping System (SAP, Boston Scientific) and the Pathfinder Plus (PP, Utah Medical Products), using Uroflow (Delphis KT) and a Dynamometer for grip strength (Sammons Preston). RESULTS The US required the shortest time for both wire insertion and basket insertion (p=0.005, and p<0.001, respectively), while the BSS had the greatest time for laser fiber insertion (p<0.005). The REF ABP required the greatest force for withdrawal of all instruments through a closed seal, while the US required the least force for laser fiber withdrawal and insertion (p<0.001). The US was leak-free at pressures up to 200 mm Hg, while all other devices had a LPP ranging from 30 to 200 mm Hg. The SAP's average and peak flow were significantly higher than that of the PP (3.5 vs. 2.1 mL/s, p<0.002, 13.1 vs. 4.43 mL/s, p<0.01, respectively). Mean grip strength decreased significantly after operation of the SAP for ten minutes, while no loss of grip strength was observed after use of the PP. CONCLUSIONS The US has the benefit of facile manipulation of wires and baskets while maintaining a water tight seal. The BSS valve is cost-effective but limited by leakage and resistance during instrument passage. The PP has less operator fatigue, but the SAP may allow for greater on-demand pressures. Further studies are required to examine the effect of irrigation systems on stone migration. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e889 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Tarplin More articles by this author Michael Byrne More articles by this author Manoj Monga More articles by this author Sri Sivalingam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...