Presented by: Jacob Thatcher DO
Jefferson, New Jersey

Introduction

Documentation of stone disease extends back thousands of years. It wasn’t until Hugh Young reported ureteroscopy in 1929 that we were able to interrogate the upper genitourinary system. Over time the maneuverability, and visibility of the ureteroscope has improved, but still the mechanics of lithotripsy and stone basket extraction in large part has remained the same.

Presently there are at least two underappreciated limitations in ureteroscopy: 1. High pressures are required for visibility, lithotripsy, and basket extraction. These high pressures lead to pyelovenous back flow and have been associated with post operative sepsis and pain, 2. Visibility is often poor, which can necessitate second look ureteroscopy.

The significance of renal pressures remains unclear. Physiologic pressure is 5-10 mmHg. Yet with irrigation devices renal pressures have been measured as high as 300 mmHg. We present a method to manage the intrarenal pressure and improve visibility by suctioning irrigant with readily available and cheap supplies available in any standard operating room.

Materials

This study was conducted in a cohort of 25 patients with large renal calculi (0.9-1.5cm) and was approved by the Institutional Review Board at Rowan School of Medicine. The patients were randomized to either the standard of care, which allowed for passive drainage through a ureteric access sheath only, or the standard of care with the addition of our suctioning device. Figure one shows the supplies used for our device, which includes a three-way UroLok™ adaptor (a), flexible ureteroscope (Olympus) and single action pump (b). Suction (Stryker Neptune™) was regulated by an Argyle™ suction catheter (c) and suction tubing (d). Figure two represents the assembled suction device during a flexible ureteroscopy. In both groups, we measured the fluid irrigated with the single action pump and compared it with the fluid that drained passively through the ureteric access sheath. 

Results

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Surprisingly, volume of irrigation with the single action pump remained constant in both groups (~900mL). Passive drainage was also constant (~500mL). However, in our study cohort, we found that we were able to suction an additional ~300 mL of irrigant, blood clot and fine stone fragments that would have otherwise not been accounted for.

Conclusion

We show a model for a novel and inexpensive suctioning device from available supplies within any operating room that effectively suctions irrigant that would have otherwise been left in the kidney post operatively. Further work will be pursued with this model to quantifiably access visibility, case time, post operative pain and sepsis. 

Funding

None

Co-Authors

Robert Barsky, DO
New Jersey Urology