Document Detail


Intrarenal pressures generated during deployment of various antiretropulsion devices in an ex vivo porcine model.
MedLine Citation:
PMID:  20575694     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
INTRODUCTION: Pressurized saline irrigation is commonly used during ureteroscopy, which can cause an increase in intrarenal pressure leading to postoperative pain, sepsis, and renal injury due to pyelovenous and pyelolymphatic backflow. To prevent retrograde stone migration during ureteroscopic lithotripsy, antiretropulsion devices can be deployed, which may or may not protect the kidney against high intrarenal pressures. This study compares the intrarenal pressures generated during the use of two antiretropulsion devices in an ex vivo porcine model. MATERIALS AND METHODS: Using an ex vivo porcine model of the urinary system, flexible ureteroscopy was performed at the proximal, mid, and distal ureter. Intrarenal pressures were measured in the absence and presence of a coil-based antiretropulsion device and a multifold film-based device. Intrarenal pressure measurements were obtained while using saline irrigation at a gravity of 84 cm H(2)O and pressures of 150 and 300 mm Hg. RESULTS: The deployment of a coil device resulted in a significant increase in intrarenal pressures during ureteroscopy with pressurized irrigation when compared with intrarenal pressures without a device. The use of a multifold film device that occluded the ureter during ureteroscopy resulted in a decrease in intrarenal pressures at an irrigation pressure of 300 mm Hg when compared with pressures without a device. In the remaining configurations, the intrarenal pressures were only minimally elevated. When comparing the two devices to each other, the multifold film device had significantly lower intrarenal pressures at each configuration. This has potential implications in preventing renal injury and/or sepsis during ureteroscopy. CONCLUSION: The use of a multifold film antiretropulsion device during ureteroscopy with high-pressure irrigation can potentially protect the kidney from elevated intrarenal pressures.
Authors:
Lara K Suh; Michael B Rothberg; Jaime Landman; Hiroshi Katsumi; Mantu Gupta
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endourology / Endourological Society     Volume:  24     ISSN:  1557-900X     ISO Abbreviation:  J. Endourol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8807503     Medline TA:  J Endourol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1165-8     Citation Subset:  IM    
Affiliation:
Department of Urology, Columbia University Medical Center, New York, New York 10032, USA. ls2574@columbia.edu
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