Mp45-18 Intrarenal Pressures (Irp) During Percutaneous Nephrolithotomy (Pcnl): Randomized Control Trial Comparing 24f to Minipcnl Suction (S-Mpcnl) and Minipcnl Non-Suction (Ns-Mpcnl) Sheaths

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP45)1 May 2024MP45-18 INTRARENAL PRESSURES (IRP) DURING PERCUTANEOUS NEPHROLITHOTOMY (PCNL): RANDOMIZED CONTROL TRIAL COMPARING 24F TO MINIPCNL SUCTION (S-MPCNL) AND MINIPCNL NON-SUCTION (NS-MPCNL) SHEATHS Raymond Khargi, Kavita Gupta, Anna Ricapito, Chris Connors, Alan Yaghoubian, Blair Gallante, William Atallah, and Mantu Gupta Raymond KhargiRaymond Khargi , Kavita GuptaKavita Gupta , Anna RicapitoAnna Ricapito , Chris ConnorsChris Connors , Alan YaghoubianAlan Yaghoubian , Blair GallanteBlair Gallante , William AtallahWilliam Atallah , and Mantu GuptaMantu Gupta View All Author Informationhttps://doi.org/10.1097/01.JU.0001008764.86460.8e.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: IRPs generated during PCNL may have the potential to cause renal damage and/or sepsis. We assessed IRPs during each step of the PCNL procedure, comparing 24F PCNL to s-mPCNL and ns-mPCNL. METHODS: Patients were randomized into 3 groups: s-mPCNL with single-step dilator (ClearPetra™, 18F, n=10), ns-mPCNL with metallic dilator and sheath (Storz MIP-M, 17.5F, n=10), or 24F PTFE with balloon dilator (Nephromax, n=10). IRP was measured with a 0.014" COMET™II Pressure Guidewire (Boston Scientific©) retrograde positioned in the renal pelvis. Gravity irrigation was utilized. Pressure data captured include baseline IRPs, retrograde pyelogram (RPG), needle entry, fascial dilation, tract dilation, sheath insertion, nephroscopy, and lithotripsy. Primary outcomes were differences in mean and peak IRP (p-IRP) during each stage. Categorical data was compared using Chi-square or Fisher's exact tests. Continuous variables were analyzed using Mann-Whitney U-tests. RESULTS: 30 patients were randomized (Table 1). Peak and mean IRPs (mmHg) were similar during baseline, RPG, needle insertion, and fascial dilation in all 3 groups (Figure 1). During tract dilation and sheath placement, 24F sheath placement generated significantly lower p-IRP compared to s-mPCNL and ns-mPCNL groups. (dilation: 6.93 vs 36.6 and 38.6, p40 mmHg was transient for all patients and occurred when the nephroscope was placed in a narrow infundibulum. CONCLUSIONS: Highest IRPs are generated during RPG. 24F balloon dilation generates lower p-IRP compared to co-axial dilation. Compared to 24F and s-mPCNL, ns-mPCNL have higher p-IRP during nephroscopy. Further research assessing the link of IRP to postop pain, sepsis, and renal injury is needed. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e749 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Raymond Khargi More articles by this author Kavita Gupta More articles by this author Anna Ricapito More articles by this author Chris Connors More articles by this author Alan Yaghoubian More articles by this author Blair Gallante More articles by this author William Atallah More articles by this author Mantu Gupta More articles by this author Expand All Advertisement PDF downloadLoading ...