Intrarenal pressures during percutaneous nephrolithotomy: a porcine kidney model

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Date
2022-05-12
Authors
Yap, Lee Chien
Hogan, Donnacha
Patterson, Kenneth
McGuinness, Gerard
O'Connor, Charles
Sharfi, Ashraf
Hennessey, Derek Barry
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Taylor & Francis
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Abstract
Background: Increased intrarenal pressure during endoscopic lithotripsy is associated with increased adverse outcomes. The objective of this study was to evaluate the effect of various devices on IRP during percutaneous intrarenal surgery in ex vivo porcine kidney models. Methods: Whole intact porcine urinary tracts were harvested. Intrarenal pressure was measured using cystometrometry software. Intrarenal pressure during PCNL was recorded using variations of percutaneous access sheath size, irrigation height of 100 cm and 60 cm, use of a ureteric catheter and use of suction. The primary outcome was absolute IRP measurements. Secondary outcomes were comparisons of IRP between techniques. Results: Using a 30 Fr vs 26 Fr access sheath and 26 Fr nephroscope the mean pressure at an irrigation height of 60 cm was significantly lower than 100 cm (p = 0.0013 vs p < 0.0001, respectively). Pressure’s during mini-PCNL were significantly higher than conventional PCNL in all variations. Using the 16.5 Fr access sheath and 12 Fr nephroscope produced a significantly lower pressure at a 60 cm irrigation height than 100 cm (p = 0.0010). IRP was significantly lower with a ureteric catheter in place vs no ureteric catheter at 100 cm (p = 0.0015) and at 60 cm (p = 0.0040). Conclusions: Using standard PCNL tract sizes intrarenal pressure varied significantly depending on the height of the irrigation fluid. Mini-PCNL is at higher risk of pathological pressure, however, the use of a ureteric catheter significantly decreased pressure. To maintain safe IRP during PCNL urologists should be aware of these significant variations.
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Keywords
PCNL , Intrarenal pressure , Access sheath
Citation
Yap, L. C., Hogan, D., Patterson, K., McGuinness, G., O’Connor, C., Sharfi, A. and Hennessey, D. B. (2022) 'Intrarenal pressures during percutaneous nephrolithotomy: a porcine kidney model', Scandinavian Journal of Urology, 56(3), pp. 251-254. doi: 10.1080/21681805.2022.2073387
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© 2022, Acta Chirurgica Scandinavica Society. This is an Accepted Manuscript of an item published by Taylor & Francis in Scandinavian Journal of Urology on 12 May 2022, available online: https://doi.org/10.1080/21681805.2022.2073387