Presented by: Justin Achua MD
University of Colorado Anschutz Medical Campus

Introduction

Since our initial reported series describing ultra-low-dose (ULD) intraoperative CT (ICT) during treatment of large stones (n=23), including ureteroscopy (URS) cases, we developed a novel and simple retrograde suction technique to manage poor visualization during dusting.  This technique also has improved ICT imaging and allowed rapid decrease in intra-renal pressure (IRP) using the LithoVue Elite (LVE) pressure monitoring scope (Boston Scientific).

Materials

“Suction through Ureteroscope Channel of Kidney-stone Dust for Ultimate Stone Treatment” (SUCKDUST) technique uses suction tubing advanced through a 10 mL Luer-lock syringe. The syringe is attached to the side port of a Urolok irrigation device with external suction set to 200-250 mm Hg. The scope is withdrawn to the renal pelvis; and the valve is opened (0.5-2s) to suction debris. The valve is closed before the collecting system collapses to avoid potential trauma. The technique was recently modified (m-SUCKDUST) for finely controlled suction appropriate for a calyx or near the urothelium, allowing variable strength and immediate cessation of suction.

Results

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SUCKDUST technique has been used in 11 URS cases, including 9/11 (82%) of cases using the LVE (m-SUCKDUST, n=4).  With IRP ≥40 mmHg, SUCKDUST allowed pressures to immediately drop (<10 mm Hg) in absence of channel instruments.  All three cases with repeated ULD ICT had substantial improvement in residual dust following SUCKDUST, including complete resolution of a 2.4 cm diameter dust collection in one case.

Conclusion

Our simple retrograde suction technique allows for clearance of dust and rapid IRP reduction.  Besides improving ICT interpretations, SUCKDUST may be particularly beneficial for patients with infected stones or who are anticoagulated when measured IRP exceeds acceptable thresholds. SUCKDUST could also have potential to improve stone-free rates.

Funding

None

Co-Authors

Eric Ballon-Landa, MD, MPH
Rocky Mountain Regional Veterans Administration Medical Center

Brett Weisen, MD
University of Colorado Anschutz Medical Campus

Granville Lloyd, MD
Rocky Mountain Regional Veterans Administration Medical Center

Mark Sawyer, MD
Rocky Mountain Regional Veterans Administration Medical Center