You have accessJournal of UrologyCME1 May 2022PD19-09 SEEING IS BELIEVING: OPTIMIZING RENAL PELVIC PRESSURE IMPROVES VISUALIZATION DURING ENDOSCOPIC COMBINED INTRARENAL SURGERY Cayde Ritchie, John Hartman, Akin Amasyali, John Jung, Aviram Assidon, Joshua Belle, and D. Duane Baldwin Cayde RitchieCayde Ritchie More articles by this author , John HartmanJohn Hartman More articles by this author , Akin AmasyaliAkin Amasyali More articles by this author , John JungJohn Jung More articles by this author , Aviram AssidonAviram Assidon More articles by this author , Joshua BelleJoshua Belle More articles by this author , and D. Duane BaldwinD. Duane Baldwin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002557.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Endoscopic combined intrarenal surgery (ECIRS), involving percutaneous renal access and retrograde ureteroscopy, achieves high stone free rates by allowing ureteroscopic visualization of calyces difficult to see with an antegrade approach. Visibility during ureteroscopy relies on irrigation through a 3Fr working channel, limiting the ability to clear blood and debris. Low irrigation rates also result in collapse of the collecting system, further limiting calyceal visualization. We have noted that visibility can be improved by placing the irrigation stopcock into the percutaneous sheath. The purpose of this study was to compare renal pelvic pressure (RPP) and retrograde ureteroscopic visibility during ECIRS, with and without access sheath irrigation (ASI), to determine the safety and efficacy of this technique. METHODS: Prospectively collected RPP measurements from 15 patients undergoing ECIRS at a single academic institution were retrospectively reviewed. During retrograde ureteroscopic renal mapping, a pressure monitor was connected to the working channel of a flexible ureteroscope. With the tip of the ureteroscope in the renal pelvis, RPP measurements were performed with and without ASI. Irrigation was maintained at a standard height of 1.28m. Study endpoints were RPP and endoscopic visibility, based on a blinded review of intraoperative photos by ten urologists using a 10-point Likert scale. Statistical analysis was performed using a paired samples t-test and Mann-Whitney U test, with significance defined as p<0.05. RESULTS: Antegrade ASI yielded significantly greater RPP (25.9 vs. 8.5 mmHg, p<0.001) and improved subjective visibility (6.9 vs. 1.9, p<0.001), when compared to ECIRS without antegrade flow. Using ASI, RPP never exceeded the approximate 35 mmHg threshold for pyelovenous backflow. Intra-operative pictures display greater collecting system distension, higher clarity of instruments, and less bleeding obscuring the field (Fig. 1). CONCLUSIONS: Antegrade access sheath irrigation represents a novel strategy for optimizing renal pelvic pressure and endoscopic visibility during ECIRS. Delivering continuous antegrade irrigation is a safe and effective method to improve visibility, without exceeding the threshold for pyelovenous backflow. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e352 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cayde Ritchie More articles by this author John Hartman More articles by this author Akin Amasyali More articles by this author John Jung More articles by this author Aviram Assidon More articles by this author Joshua Belle More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF DownloadLoading ...