V02-08 SIMPLE, REAL-TIME INTRAOPERATIVE INTRARENAL PRESSURE MONITORING: METHODS AND APPLICATIONS

Abstract

You have accessJournal of UrologyMisc. Benign Disease & Transplant & Renovascular (V02)1 Sep 2021V02-08 SIMPLE, REAL-TIME INTRAOPERATIVE INTRARENAL PRESSURE MONITORING: METHODS AND APPLICATIONS Nabeel Shakir, and Lee Zhao Nabeel ShakirNabeel Shakir More articles by this author , and Lee ZhaoLee Zhao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001979.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION: AND OBJECTIVE: Historic methods of measuring intrarenal pressure such as the Whitaker test have required specialized equipment needing precise calibration. With the advent of sophisticated anesthesia monitors, pressure transducers are available in most operating rooms. We present our technique for measuring intrarenal pressure (IRP) intraoperatively with common equipment. Our hypothesis is that with relief of obstruction, IRP will decrease and remain low. METHODS: Sterile arterial line tubing is zeroed and connected to a nephrostomy tube with a Luer lock adapter and a three way stopcock to allow for periodic venting. A urethral catheter keeps the bladder drained. The transduced IRP is recorded automatically in the anesthesia log. Initially, IRP rises due to urine accumulating in the renal pelvis, with an unrelieved obstruction. When IRP rises beyond a preset threshold, the nephrostomy is drained. The IRP will rise again until the obstruction is relieved. When the obstruction is corrected, it should remain low. RESULTS: We present cases where we implemented this technique. The first case is of a left ureteral transection managed with robotic Boari flap. When the ureter is incised, there is a rush of pressurized urine. Concomitantly, the intrarenal pressure decreases, and remains low during reconstruction. The second case is of robotic left ureterolysis due to retroperitoneal fibrosis. Here we demonstrate venting the nephrostomy, which allows the intrarenal pressure to decrease safely. Concurrent ureteroscopy demonstrates no synchronous intrinsic obstruction. The IRP has decreased and remains low, without further need to drain the nephrostomy.The final case is of bilateral ureteral obstruction. Here, the right ureteropelvic junction is seen in a bed of dense fibrosis. When the right ureter has been incised anteriorly there is a drop in intrarenal pressure noted simultaneously. This persists while the ureter is being spatulated. Patency outcomes to date have been excellent (6/7 patients) without additional morbidity secondary to IRP measurement. CONCLUSIONS: This technique is now a routine component for our upper urinary tract reconstructive practice, leveraging commonplace equipment. There is minimal additional cost or operating time. Apart from allowing for IRP measurement, and verifying relief of obstruction, potential future applications include ureteroscopy for stone disease. Further investigation into the significance of the decrease in pressure, and of other measured parameters, may yield greater insights into renal and ureteral obstructive disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e135-e136 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nabeel Shakir More articles by this author Lee Zhao More articles by this author Expand All Advertisement Loading ...