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Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments
Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments

INTRODUCTION: Flexible ureterorenoscopy is becoming a first-line treatment for many intrarenal stones. Ureteric access sheaths are commonly used to aid access, stone removal and reduce intrarenal pressure. We evaluated the effects of two commonly used access sheaths on irrigation flow and intrarenal pressure during flexible ureterorenoscopy. We measured the effect of scope instrumentation on flow and pressure.

MATERIAL AND METHODS: We utilized a 10/12F and 12/14F, 35 cm Re-Trace™ access sheath with a FlexX2 scope in a cadaveric porcine kidney. We evaluated the effect of four Nitinol baskets (1.3F, 1.5F, 1.9F, 2.2F), three different 200 µm laser fibres and a hand-held pump. Measurements of irrigation flow and intrarenal pressure were recorded and compared between the different sized access sheaths.

RESULTS: Flow rates varied widely between access sheaths. Without instrumentation, mean flow was 17 mls/min (10/12F access sheath), versus 33 mls/min (12/14F sheath) (p <0.0001). Increasing basket size produced a gradual reduction in flow and pressure in both access sheaths. Reassuringly, pressures were low overall (<40 cm H2O). Pressures were significantly reduced when using the larger 12/14F sheath, with and without all instrumentations (p <0.0001). Hand-held pump devices have a marked effect on flow and pressure in both sheaths; with pressures rising up to 121 cm H2O with a 10/12F sheath, versus 29 cm H2O (12/14F) (p <0.0001).

CONCLUSIONS: A 12/14F access sheath offered significantly improved irrigation whilst maintaining significantly lower intrarenal pressure, when compared to a 10/12F access sheath in a cadaveric porcine model. Scope instrumentation affects irrigation flow and pressure in both sized sheaths. Furthermore, there should be caution with hand-held pump devices, especially with smaller sized sheaths, as intrarenal pressure can be very high.

Journal Article
2080-4806
434-438
Wright, Anna
dbd617f3-702b-4ed2-955c-f82428cac9f5
Williams, Kevin
693eb4f9-a825-4ca4-a2d0-b6c31e0ce07d
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Rukin, Nicholas
30714cb4-88de-4fbd-a957-4762b8cc8fb5
Wright, Anna
dbd617f3-702b-4ed2-955c-f82428cac9f5
Williams, Kevin
693eb4f9-a825-4ca4-a2d0-b6c31e0ce07d
Somani, Bhaskar
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Rukin, Nicholas
30714cb4-88de-4fbd-a957-4762b8cc8fb5

Wright, Anna, Williams, Kevin, Somani, Bhaskar and Rukin, Nicholas (2015) Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments. Central European Journal of Urology, 68 (4), 434-438. (doi:10.5173/ceju.2015.604).

Record type: Article

Abstract

INTRODUCTION: Flexible ureterorenoscopy is becoming a first-line treatment for many intrarenal stones. Ureteric access sheaths are commonly used to aid access, stone removal and reduce intrarenal pressure. We evaluated the effects of two commonly used access sheaths on irrigation flow and intrarenal pressure during flexible ureterorenoscopy. We measured the effect of scope instrumentation on flow and pressure.

MATERIAL AND METHODS: We utilized a 10/12F and 12/14F, 35 cm Re-Trace™ access sheath with a FlexX2 scope in a cadaveric porcine kidney. We evaluated the effect of four Nitinol baskets (1.3F, 1.5F, 1.9F, 2.2F), three different 200 µm laser fibres and a hand-held pump. Measurements of irrigation flow and intrarenal pressure were recorded and compared between the different sized access sheaths.

RESULTS: Flow rates varied widely between access sheaths. Without instrumentation, mean flow was 17 mls/min (10/12F access sheath), versus 33 mls/min (12/14F sheath) (p <0.0001). Increasing basket size produced a gradual reduction in flow and pressure in both access sheaths. Reassuringly, pressures were low overall (<40 cm H2O). Pressures were significantly reduced when using the larger 12/14F sheath, with and without all instrumentations (p <0.0001). Hand-held pump devices have a marked effect on flow and pressure in both sheaths; with pressures rising up to 121 cm H2O with a 10/12F sheath, versus 29 cm H2O (12/14F) (p <0.0001).

CONCLUSIONS: A 12/14F access sheath offered significantly improved irrigation whilst maintaining significantly lower intrarenal pressure, when compared to a 10/12F access sheath in a cadaveric porcine model. Scope instrumentation affects irrigation flow and pressure in both sized sheaths. Furthermore, there should be caution with hand-held pump devices, especially with smaller sized sheaths, as intrarenal pressure can be very high.

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More information

Accepted/In Press date: 1 September 2015
e-pub ahead of print date: 2 November 2015
Published date: 2015
Keywords: Journal Article

Identifiers

Local EPrints ID: 419378
URI: http://eprints.soton.ac.uk/id/eprint/419378
ISSN: 2080-4806
PURE UUID: 5b1fbbe1-7aaa-4392-a1d4-da7cae9e9472

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Date deposited: 11 Apr 2018 16:30
Last modified: 20 Mar 2020 17:31

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