Mp43-09 Optimization of Renal Pelvic Pressures During Pcnl: The Effects of Sheath Configuration, Instrumentation, and Irrigation

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology II (MP43)1 May 2024MP43-09 OPTIMIZATION OF RENAL PELVIC PRESSURES DURING PCNL: THE EFFECTS OF SHEATH CONFIGURATION, INSTRUMENTATION, AND IRRIGATION Kyu Park, Sikai Song, Nicole Mack, Cliff De Guzman, Toby Clark, Matthew Buell, Rose Leu, Kanha Shete, Akin S. Amasyali, Ala'a Farkouh, Elizabeth A. Baldwin, Evan Seibly, and D. Duane Baldwin Kyu ParkKyu Park , Sikai SongSikai Song , Nicole MackNicole Mack , Cliff De GuzmanCliff De Guzman , Toby ClarkToby Clark , Matthew BuellMatthew Buell , Rose LeuRose Leu , Kanha SheteKanha Shete , Akin S. AmasyaliAkin S. Amasyali , Ala'a FarkouhAla'a Farkouh , Elizabeth A. BaldwinElizabeth A. Baldwin , Evan SeiblyEvan Seibly , and D. Duane BaldwinD. Duane Baldwin View All Author Informationhttps://doi.org/10.1097/01.JU.0001008720.96896.83.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated renal pelvic pressure (RPP) during percutaneous nephrolithotomy (PCNL) increases pyelovenous backflow and infection risk. In contrast, low RPP may affect visualization, increase venous bleeding, and risk mucosal injury. In PCNL, surgeons use a variety of scope configurations, irrigation strategies, and instrumentation techniques that may affect RPP. The purpose of this study was to compare RPP during a PCNL with a rigid nephroscope using a variety of sheath, irrigation, and instrument combinations in a benchtop model. METHODS: Three silicone kidneys were created from a 3D model based on a patient's CT. Renal access was established by placing a 30 Fr sheath in the upper, middle, or lower pole calyx. The kidney models were placed in a torso model to reproduce the anatomic position of a kidney during prone PCNL. RPP was measured via an arterial line transducer connected to the working port of a flexible ureteroscope inserted into the ureter. Five trials were performed for each of the following comparisons: (1) irrigation through a 26 Fr rigid nephroscope with and without metal sheath, (2) irrigation connected to the inflow or outflow port through a 26 Fr rigid nephroscope with metal sheath, and (3) with or without various instruments, including a two-prong grasper (2PG), and ultrasonic lithotripter (UL) with and without suction. Statistical analysis was performed using the Wilcoxon test, with p0.05 for all). Use of the UL with suction significantly reduced RPPs in all scenarios (p<0.001). CONCLUSIONS: This study demonstrates several strategies for optimizing RPP during PCNL. Low pressure can be maintained by avoiding the metal sheath, irrigating through the inflow port, and continuous suction. In contrast, in patients with non-infectious stones who are experiencing venous bleeding, RPP can be increased to optimize visualization by irrigating through the outflow, using the metal sheath, and reducing the suction. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e696 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kyu Park More articles by this author Sikai Song More articles by this author Nicole Mack More articles by this author Cliff De Guzman More articles by this author Toby Clark More articles by this author Matthew Buell More articles by this author Rose Leu More articles by this author Kanha Shete More articles by this author Akin S. Amasyali More articles by this author Ala'a Farkouh More articles by this author Elizabeth A. Baldwin More articles by this author Evan Seibly More articles by this author D. Duane Baldwin More articles by this author Expand All Advertisement PDF downloadLoading ...