Abstract: PD35-08
Sources of Funding: None

Introduction

Ureteroscopy (URS) is a common urologic procedure for removing upper urinary tract stones and evaluating other abnormalities of the urinary tract. Pressurized irrigation is frequently used to aid visualization by increasing the flow through the working channel. However, this can lead to postoperative renal colic, intrarenal reflux, rupture of the fornix, and, more seriously, sepsis, especially in the absence of ureteral access sheath (UAS). Here within, we evaluate the safety of pressurized irrigation during ureteroscopy in the absence of UAS.

Methods

After IRB approval, a retrospective chart review was performed comparing patients in whom pressurized irrigation was used during URS in the absence of UAS to those in whom pressure was not used from February 2014 to September 2016. Pressurized irrigation was performed utilizing automated external compression to the irrigation bag with maximum pressure set at 150 mm Hg; in the other cohort, hand irrigation was performed using 60 ml syringe and IV extension tubing. Statistics were performed in Prism (Graph Pad) and included means, standard deviations, chi squared tests, and student&[prime]s t-tests.

Results

Group (A) consisted of 206 patients in which pressurized irrigation was used. Group (B) consisted of 25 patients in which hand irrigation was used during their URS. In group (A), 52.9% were male vs in group (B), 36%. Group (B) were younger on average, with a mean age of 43±18.5, compared with group (A) whose mean age was 53±19.2 (p<0.05). In Group (A), 110/206 patients were stented preoperatively compared with 15/25 in Group (B) (p=0.67). Procedure times were 59±44 minutes in Group (A) and 67±35 minutes in Group (B) (p=0.38) Complication rates were 13.1% vs 24% in groups (A) and (B), respectively (P=0.14). Emergency Department (ED) return rate was 27 (13.1%) vs 6 (24%) in groups (A) and (B), respectively (P=0.14). Most complications in both cohorts were Urinary tract infection (UTI) and pain-associated complications. UTI was encountered in 5 vs 3 patients in groups (A) and (B), respectively (p<0.05). No occurrences of sepsis in either group. There was no calyceal rupture or intraoperative extravasation in either cohort.

Conclusions

Pressurized irrigation in the absence of UAS during URS appears to be safe. There was no significant difference in procedure times and, although there were more complications and ED visits in the hand irrigation group, many of these were experienced by a single patient who experienced a significant number of complications.

Funding

None