You have accessJournal of UrologyCME1 Apr 2023MP35-04 SERIAL MANUAL “PUMP” IRRIGATION LEADS TO CRITICAL INTRA-RENAL PRESSURES DURING URETERO-RENOSCOPY – TIME TO ABANDON THIS MANOEUVRE Anne Hong, Gregory Jack, Cliodhna Browne, and Damien Bolton Anne HongAnne Hong More articles by this author , Gregory JackGregory Jack More articles by this author , Cliodhna BrowneCliodhna Browne More articles by this author , and Damien BoltonDamien Bolton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy has become the dominant method of managing urolithiasis. Various methods of irrigation can be utilized to maintain clear views. One such method is the manual pump irrigation, whereby a bolus of fluid is delivered from a chamber in the irrigation system. However raised intrarenal pressures (IRPs) during ureteroscopy consequently ensue, and are of concern due to associated post operative complications. Clinically, this has been correlated with outcomes such as infection, pain, and excessive fluid absorption. We aimed to characterise the increases and maximal IRPs produced by manual pump irrigation used during uretero-renoscopy. METHODS: During the uretero-renoscopy procedure a Comet II Pressure Guidewire® (Boston Scientific Corporation, Marlborough, Massachusetts, USA) was used for IRP measurement. Routine flexible uretero-renoscopy for treatment of urolithiasis was undertaken, including manual pump irrigation where this was required to maintain vision. The baseline IRPs, maximal IRPs and the difference between the two were calculated. RESULTS: A total of 17 single manual pump manoeuvres were observed during treatment of this cohort. The median baseline IRP was 36.5 mmHg, the median rise in IRP was 29.4 mmHg, and the median maximum IRP achieved was 76.0 mmHg. A total of 24 serial manual pump manoeuvres were analyzed with the median baseline 39.3 mmHg. After the serial hand pump maneuver, the median rise in IRP was 72.3 mmHg, with the median maximum IRP achieved being 114.1 mmHg. CONCLUSIONS: Manual pump irrigation - both single but particularly serial maneuvers - produces significant rises in IRPs and that could logically result in pyelo-venous backflow and sepsis. Our results suggest that this manoeuvre should be avoided, in order to reduce potential complications of flexible uretero-renoscopy. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e469 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Hong More articles by this author Gregory Jack More articles by this author Cliodhna Browne More articles by this author Damien Bolton More articles by this author Expand All Advertisement PDF downloadLoading ...