Mp45-17 Review of the Safety of Sterile Water Compared to Normal Saline as Irrigation Solution in Ureteroscopy

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP45)1 May 2024MP45-17 REVIEW OF THE SAFETY OF STERILE WATER COMPARED TO NORMAL SALINE AS IRRIGATION SOLUTION IN URETEROSCOPY Shiv N. Kandappah, Luke D. E. Witherspoon, Luke F. Reynolds, and Humberto R. Vigil Shiv N. KandappahShiv N. Kandappah , Luke D. E. WitherspoonLuke D. E. Witherspoon , Luke F. ReynoldsLuke F. Reynolds , and Humberto R. VigilHumberto R. Vigil View All Author Informationhttps://doi.org/10.1097/01.JU.0001008764.86460.8e.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Normal saline (NS) is the widely accepted standard irrigation solution for ureteroscopy (URS) due to a theoretical limitation of the risk of hyponatremia, hemolysis, and heart failure compared to sterile water (SW). However, a 2021 study by Pirani et al. suggests that SW offers better visualization with no increased risk of hyponatremia. The objective of this study was to assess whether SW irrigation for URS is associated with increased rates of post-operative complications compared to NS. METHODS: A retrospective chart review was performed on patients who underwent URS at a high-volume tertiary care center. After excluding patients who received both NS and SW irrigation intraoperatively, patients were divided into one of two cohorts: URS with SW or URS with NS. Demographic, surgical and both 90 and 30-day post-operative data was recorded. The primary outcomes were the 90-day post-URS rates of three specific events: (1) emergency department (ED) presentations, (2) hospital re-admissions, and (3) mortality. Secondary outcomes included the 30-day post-URS rates of serum abnormalities in sodium (Na), potassium (K), chloride (Cl), and hemoglobin (Hgb). A chi-squared analysis was then conducted to detect any significant differences in rates between the groups. RESULTS: Between June 1, 2022 and June 30, 2023, 1001 patients with a median age of 62 years underwent URS with a median operative time of 37 minutes. 58% of patients underwent inpatient URS and 42% underwent day surgery. The SW group had 677 patients and the NS group had 320 patients. There were no significant differences in the 90-day post-URS rates of ED presentation (SW=21%; NS=26%; p=0.075), hospital re-admission (SW=21%; NS=24%; p=0.36) or mortality (SW=1.3%; NS=1.9%; p=0.51) between groups. There were no significant differences between groups in the 30-day post-URS rates of serum abnormalities (Na [p=0.67], K [p=0.71], Cl [p=0.92], Hgb [p=0.30]) amongst patients who had normal pre-operative values. CONCLUSIONS: At a high-volume tertiary care center, there were no significant differences in the rates of the complications studied between SW and NS irrigation types. SW irrigation emerges as a safe option for URS, offering the potential for enhanced visualization compared to NS, and, as such, can be considered the standard irrigation solution for URS. 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 Shiv N. Kandappah More articles by this author Luke D. E. Witherspoon More articles by this author Luke F. Reynolds More articles by this author Humberto R. Vigil More articles by this author Expand All Advertisement PDF downloadLoading ...