PD28-09 A MULTI-INSTITUTIONAL ANALYSIS OF HUMAN IN VIVO INTRARENAL PRESSURE DURING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD28-09 A MULTI-INSTITUTIONAL ANALYSIS OF HUMAN IN VIVO INTRARENAL PRESSURE DURING URETEROSCOPY Stefanie Croghan, Sorcha O'Meara, Eoghan Cunnane, Connor Cunnane, Muheilan Muheilan, Mutaz Elamin, Kenneth Patterson, Steven Anderson, Jody Khan, James Forde, Rustom Manecksha, Fergal O'brien, Michael Walsh, and Niall Davis Stefanie CroghanStefanie Croghan More articles by this author , Sorcha O'MearaSorcha O'Meara More articles by this author , Eoghan CunnaneEoghan Cunnane More articles by this author , Connor CunnaneConnor Cunnane More articles by this author , Muheilan MuheilanMuheilan Muheilan More articles by this author , Mutaz ElaminMutaz Elamin More articles by this author , Kenneth PattersonKenneth Patterson More articles by this author , Steven AndersonSteven Anderson More articles by this author , Jody KhanJody Khan More articles by this author , James FordeJames Forde More articles by this author , Rustom ManeckshaRustom Manecksha More articles by this author , Fergal O'brienFergal O'brien More articles by this author , Michael WalshMichael Walsh More articles by this author , and Niall DavisNiall Davis More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Elevated intrarenal pressure is a proposed risk factor for adverse clinical outcomes in endourology. However, minimal human data exists on baseline or ureteroscopic pressures within the upper urinary tract. We aimed to quantify in vivo intrarenal pressure in a consecutive patient sample undergoing ureteroscopy and assess for correlation between pressure dynamics and clinical outcome. METHODS: A prospective, multi-institutional study was designed with ethical approval. One hundred consenting adult patients undergoing elective ureteroscopy were included. The Comet™ II Pressure Guidewire (Boston Scientific), was placed retrograde within the renal pelvis under fluoroscopy prior to ureteroscopy. Semi-rigid and/or flexible ureteroscopy/renoscopy was performed according to surgeon’s standard practice. The AVVIGOTM (Boston Scientific) System provided live intrarenal pressure recordings, to which the operating surgeon was blinded. Baseline and ureteroscopic intrarenal pressures were recorded. Thirty-day follow up of clinical outcomes was completed and statistical analysis performed. RESULTS: Analysis of 309 unique pressure traces from 100 consecutive patients (56 male; 44 female) was performed. Mean patient age was 57.21±13.73 years. Ureteroscopy was performed for urolithiasis in 94% (n=94) and for other diagnostic indications in 6% (n=6); 26% (n=26) were pre-stented. The mean resting baseline intrarenal pressure (IRP) was 17.47±10.66 mmHg. Semi-rigid ureteroscopy (URS) was performed with a 6.5-7.5Fr ureteroscope in 30% (n=30), with mean IRP 39.55±17.66 mmHg. Flexible ureterorenoscopy (FURS) with a 9.1-10Fr instrument was performed in 93% (n=93). FURS without a ureteral access sheath (UAS) resulted in mean IRP 38.12±16.33 mmHg. FURS using an 11/13Fr UAS resulted in IRPs (mean±SD) of 30.1±20.48mmHg (gravity irrigation); 43.04±24.87mmHg (pressurised irrigation at 100mmHg); 46.53±25.05mmHg (pressurised irrigation at 150mmHg) and 79.74±61.66 (pressurised irrigation at 200mmHg). Readmission with pyrexia occurred in 4% (n=4); mean procedural IRP in this cohort was significantly higher than controls at 120.25±67.88mmHg versus 41.3±26.4mmHg(p<0.001). CONCLUSIONS: Both baseline intra-renal pressures and ureteroscopic pressures exhibit variability. Intraoperative IRP is related to technical variables. High intrarenal pressure values are positively correlated with postoperative pyrexia, however the complication pressure threshold appears to be higher than previously thought. Source of Funding: Boston Scientific (Investigator Sponsored Research product grant). © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e822 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stefanie Croghan More articles by this author Sorcha O'Meara More articles by this author Eoghan Cunnane More articles by this author Connor Cunnane More articles by this author Muheilan Muheilan More articles by this author Mutaz Elamin More articles by this author Kenneth Patterson More articles by this author Steven Anderson More articles by this author Jody Khan More articles by this author James Forde More articles by this author Rustom Manecksha More articles by this author Fergal O'brien More articles by this author Michael Walsh More articles by this author Niall Davis More articles by this author Expand All Advertisement PDF downloadLoading ...