Presented by: Anne Hong MD
Austin Health

Introduction

Uretero-renoscopy has become the dominant method of managing urolithiasis. Various methods of irrigation can be utilized to maintain clear views. One such method is the manual bolus irrigation, whereby a bolus of fluid is delivered from a chamber or syringe in the irrigation system. Raised intrarenal pressures (IRPs) will logically ensue from such fluid instillation, and this is of concern due to associated post-operative complications. Deaths have been reported as a consequence of sepsis related to uretero-renoscopy. We aim to characterize the fluctuations and maximal IRPs produced by manual bolus irrigation used during uretero-renoscopy.

Materials

A pressure guidewire was used for IRP measurement during routine flexible uretero-renoscopy, including manual bolus irrigation when required to maintain vision. The fluid bolus was either as a single manual bolus or a series of manual boluses in quick succession. The baseline IRPs, maximal IRPs and the difference between the two were calculated.

Results

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10 procedures in 9 patients were analyzed. 20 single manual boluses were observed. The median baseline IRP was 31.23mmHg, the median rise in IRP was 28.79mmHg, and the median maximal IRP achieved was 50.85mmHg. 24 serial manual boluses were analyzed with the median baseline 39.66mmHg. After serial manual boluses, the median rise in IRP was 64.82mmHg, with the median maximum IRP achieved being 110.5mmHg. These results are summarized in Table 1.

Conclusion

Both single and serial manual bolus irrigation – but particularly serial boluses – produces significant rises in IRPs and could logically result in pyelovenous backflow and sepsis. Our results suggest that this maneuver should be avoided to reduce complications during uretero-renoscopy.

Funding

The authors received no funding for this project

Co-Authors

Greg Jack, MD, PhD
Austin Health

Cliodhna Browne, PhD
Austin Health

Damien Bolton, PhD
Austin Health