Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model.

Søren Kissow Lildal,Palle Jörn Sloth Osther,Malene Roland Pedersen,Helene Jung,Kim Hovgaard Andreassen,Frederikke Eichner Christiansen

doi:10.1155/2016/8064648

Søren Kissow Lildal, Palle Jörn Sloth Osther + Show 4 more

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https://doi.org/10.1155/2016/8064648

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Abstract

Objective. High intraluminal pressure during ureterorenoscopy (URS) increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs), which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO), when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL) or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (<PULS grade 2) were observed in the ISO group. Conclusions. Endoluminal irrigation with ISO may facilitate UAS insertion and potentially decrease UAS related ureteral lesions.

Highlights

Ureteral access sheaths (UASs) are increasingly being used for ureterorenoscopic procedures (URS)
Several recent reports have documented UAS usage to be associated with ureteral damage, which subsequently may result in stricture formation and loss of kidney function [3, 4]
We have previously shown that the β-agonist isoproterenol (ISO), when administered locally in a 0.1 μg/mL saline solution at an irrigation rate of 8 mL/min, was able to inhibit the ureteral muscle tone and lower the pressure in the upper urinary tract significantly during ureterorenoscopy without causing systemic adverse effects [7,8,9,10]

Summary

Introduction

Ureteral access sheaths (UASs) are increasingly being used for ureterorenoscopic procedures (URS). The use of UAS has been shown to decrease intrarenal pressure during URS, thereby potentially reducing risk of septic and haemorrhagic complications [1, 2]. UAS usage may be a double-edged sword: on the one hand diminishing risks related to irrigation and on the other hand increasing risks related to access in a narrow ureter [5]. We have previously shown that the β-agonist isoproterenol (ISO), when administered locally in a 0.1 μg/mL saline solution at an irrigation rate of 8 mL/min, was able to inhibit the ureteral muscle tone and lower the pressure in the upper urinary tract significantly during ureterorenoscopy without causing systemic adverse effects [7,8,9,10]

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Results

Conclusion