Mp04-02 Ureteroscopic Techniques and Anatomic Sites Associated With Periods of Elevated Intrarenal Pressure

You have accessJournal of UrologyStone Disease: Surgical Therapy (including ESWL) I (MP04)1 May 2024MP04-02 URETEROSCOPIC TECHNIQUES AND ANATOMIC SITES ASSOCIATED WITH PERIODS OF ELEVATED INTRARENAL PRESSURE Alexander Chartier, Nathan Nahhas, Priyal Chadha, Timothy Byler, and Scott Wiener Alexander ChartierAlexander Chartier , Nathan NahhasNathan Nahhas , Priyal ChadhaPriyal Chadha , Timothy BylerTimothy Byler , and Scott WienerScott Wiener View All Author Informationhttps://doi.org/10.1097/01.JU.0001008708.00982.a9.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy is considered first-line therapy for renal stones <2 cm by most urologists and recent studies have reported an approximate 5% rate of urosepsis after ureteroscopy, with pyelovenous backflow hypothesized as the mechanism for post-ureteroscopy bacteremia. The Lithovue™ Elite (Boston Scientific Corporation, Marlborough, MA, USA) is a new disposable flexible ureteroscope with the ability to provide real-time pressure monitoring from a sensor at the tip of the ureteroscope. Our objective was to describe how ureteroscopic maneuvers, lithotripsy techniques, and anatomic positioning influence pressure readings using a pressure-sensing single-use ureteroscope. METHODS: Single surgeon retrospective case series of ureteroscopy procedures during a pre-market release of the LithoVue™ Elite system from June - July, 2023. Video and pressure recordings correlated pre-defined procedural events (such as anatomic location, lithotripsy technique) to the corresponding pressure. Binary logistic regression and linear regression were performed to assess for predictors of overpressure events (≥2 seconds at ≥40 mmHg) and to assess the relative contribution of each variable to pressure during such events. RESULTS: 7 of 11 (64%) cases had satisfactory data for review. Of 163 minutes of pressure tracings, over-pressure was 5.8 minutes (8.7%) at 70.7±49.8 mmHg for hand-pump irrigation and 6.8 minutes (8.0%) at 78.6±45.7 mmHg for automated pressure irrigation. Adjusting for irrigation technique, lithotripsy technique, and anatomic location, a logistic regression found that overpressure events were less likely when using an access sheath, dusting, or fragmenting but more likely when using a pressure management system or if in a non-calyceal location. The contribution of each variable during an overpressure event was assessed by linear regression. CONCLUSIONS: Use of an access sheath and hand-pump irrigation was shown to decrease likelihood of an overpressure event. Various lithotripsy techniques were not associated with overpressure events. Operating within a calyx is generally protective of overpressure events. Further prospective, blinded, studies will allow for more accurate interpretation of pressure tracings and correlation to clinical outcomes. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e32 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alexander Chartier More articles by this author Nathan Nahhas More articles by this author Priyal Chadha More articles by this author Timothy Byler More articles by this author Scott Wiener More articles by this author Expand All Advertisement PDF downloadLoading ...