Presented by: Kavita Gupta MD
Icahn School of Medicine at Mount Sinai

Introduction

In recent years, there has been a growing emphasis on the intrarenal pressure generated during Mini-Percutaneous Nephrolithotomy (PCNL) due to its connection with renal damage and the potential for sepsis. We aimed to assess the range of pressures created in the urinary collecting system of patients undergoing Mini-PCNL.

 

Materials

This is an on-going prospective randomized controlled trial. Patients who were scheduled for mini-PCNL were included in the study after providing written consent. They were then randomly assigned to either the suction group, utilizing ClearPetra™, or the non-suction group, employing a metallic access sheath. Intrarenal pressure was measured with the 0.014” single-use COMET™II Pressure Guidewire (Boston Scientific©), positioned in a retrograde fashion into the renal pelvis. Pressure measurements were initially recorded at baseline. Average and maximum pressures were subsequently recorded at three different stages: access sheath dilation, nephroscopy, and lithotripsy. The primary outcome was comparing the average and maximum pressures during each stage between the suction and non-suction groups. Categorical variables were compared between groups using Chi-square of Fisher’s exact tests while continuous variables were analyzed using Mann-Whitney U-tests.

Results

,

A total of fifteen patients were enrolled in the study and randomly assigned to either the suction group (8/15) or the non-suction group (7/15). Maximum and average pressure was found to be similar during access sheath dilation and nephroscopy in both groups. However, during the lithotripsy component, the suction group demonstrated a significantly lower maximum pressure measurement compared to the non-suction group (9.5 mmHg vs. 34.3 mmHg, p = 0.037). Conversely, the average lithotripsy pressure did not show a statistically significant difference between the two groups.

Conclusion

Based on our preliminary findings, the average intrarenal pressure during Mini-PCNL appears to remain unchanged regardless of the utilization of a suction system. However, it is noteworthy that the maximum pressure experienced during lithotripsy is significantly lower when employing a suction sheath.

Funding

This work was supported by a grant from the New York Academy of Medicine.

Co-Authors

Alan J. Yaghoubian, MD
Icahn School of Medicine at Mount Sinai

Anna Ricapito, MD
University of Foggia, Department of Urology

Christopher Connors, BS
Icahn School of Medicine

Kavita Gupta, MD
Icahn School of Medicine at Mount Sinai

Samuel Yim, BS
Icahn School of Medicine at Mount Sinai

Blair Gallante, MPH
Icahn School of Medicine

Johnathan A. Khusid, MD
Icahn School of Medicine at Mount Sinai

William M. Atallah, MD, MPH
Icahn School of Medicine at Mount Sinai

Mantu Gupta, MD, FRCS
Icahn School of Medicine at Mount Sinai