Prospective Randomized Comparison of Standard Hand Pump Infuser Irrigation <i>vs</i> an Automated Irrigation Pump During Percutaneous Nephrolithotomy and Ureteroscopy: Assessment of Operating Room Efficiency and Surgeon Satisfaction

Jefferson, Francis; Sung, John; Limfueco, Luke; Lu, Shao Chun; Cottone, Courtney; Tapiero, Shlomi; Clayman, Ralph V.; Landman, Jaime

doi:10.1089/end.2019.0419

Cited by 8 publications

(5 citation statements)

References 21 publications

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“…showing that automated systems are more popular compared to hand pump due to ease of use and less reliance on operating room staff. [13] Some studies support that judicious use of hand irrigation can maintain low pressures, but pressures can reach dangerous levels if a careful touch is not maintained. [7] The normal physiologic intrarenal pressure is roughly 10 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Ureteroscopic Techniques and Anatomic Sites Associated with Periods of Elevated Intrarenal Pressure

Chartier,

Nahhas,

Chadha

et al. 2024

Preprint

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Purpose: To describe how ureteroscopic maneuvers, lithotripsy techniques, and anatomic positioning influence pressure readings using a pressure-sensing single-use ureteroscope. Methods: Single surgeon retrospective case series of ureteroscopy procedures during a pre-market release of the LithoVue™ Elite system from June - July, 2023. Video and pressure recordings correlated pre-defined procedural events (such as anatomic location, lithotripsy technique) to the corresponding pressure. Binary logistic regression and linear regression were performed to assess for predictors of overpressure events (≥2 seconds at ≥40 mmHg) and to assess the relative contribution of each variable to pressure during such events. Results: 7 of 11 (64%) cases had satisfactory data for review. Of 163 minutes of pressure tracings, over-pressure was 5.8 minutes (8.7%) at 70.7 ± 49.8 mmHg for hand-pump irrigation and 6.8 minutes (8.0%) at 78.6 ± 45.7 mmHg for automated pressure irrigation. Adjusting for irrigation technique, lithotripsy technique, and anatomic location, a logistic regression found that overpressure events were less likely when using an access sheath, dusting, or fragmenting but more likely when using a pressure management system or if in a non-calyceal location. The contribution of each variable during an overpressure event was assessed by linear regression. Conclusions: Use of an access sheath and hand-pump irrigation was shown to decrease likelihood of an overpressure event. Various lithotripsy techniques were not associated with overpressure events. Operating within a calyx is generally protective of overpressure events. Further prospective, blinded, studies will allow for more accurate interpretation of pressure tracings and correlation to clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Ureteroscopic Techniques and Anatomic Sites Associated with Periods of Elevated Intrarenal Pressure

Chartier,

Nahhas,

Chadha

et al. 2024

Preprint

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“…A randomized controlled trial of 51 patients in the United States undergoing percutaneous nephrolithotomy and URS found significantly less irrigation concerns, decreased pump time, and increased nurse satisfaction when using automated irrigation pumps when compared with manual pumps. 11 While there are no data on the most commonly chosen irrigation pressures in North America, a recent bench study of automated irrigation systems conducted by urologists in the United States were done at pressure settings with a maximum of 300 mmHg to mimic clinical practice. 12 In another US bench study where a setting of 200 mmHg with the pressurized saline bag was used, it was noted that a pressure in excess of 300 mmHg may occur in the operating room.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Under pressure: irrigation practice patterns during flexible ureteroscopy

Salka

Bahaee

Plott

et al. 2023

Therapeutic Advances in Urology

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Introduction: Irrigation parameters during flexible ureteroscopy (fURS) may impact patient outcomes, yet there are limited data on current practice patterns of irrigation methods and parameter selection. We assessed the common irrigation methods, pressure settings, and situations that present the most problems with irrigation among worldwide endourologists. Methods: A questionnaire on fURS practice patterns was sent to Endourology Society members in January 2021. Responses were collected through QualtricsXM over a 1-month period. The study was reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Surgeons were from North America (the United States and Canada), Latin America, Europe, Asia, Africa, and Oceania. Results: Questionnaires were answered by 208 surgeons (response rate 14%). North American surgeons accounted for 36% of respondents; 29% Europe, 18% Asia, and 14% Latin America. In North America, the most common irrigation method was the pressurized saline bag using a manual inflatable cuff (55%). Saline bag (gravity) with a bulb or syringe injection system was the most common method in Europe (45%). Automated systems were the most common method in Asia (30%). For pressures used during fURS, the majority of respondents used 75–150 mmHg. The clinical scenario which had the greatest issue with adequate irrigation was during biopsy of urothelial tumor. Conclusion: There is variation in irrigation practices and parameter selection during fURS. North American surgeons primarily used a pressurized saline bag, in contrast to European surgeons who preferred a gravity bag with a bulb/syringe system. Overall, automated irrigation systems were not commonly used.

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“…Сравнение длительности операции, SFR, осложнений и объёма использованной ирригационной жидкости с использованием ручной помпы и автоматической ирригационной системы не показало преимуществ одного метода над другим [81,82]. Для полного понимания влияния раз-личных методов ирригации на результаты лечения необходимы дополнительные исследования.…”

Section: ирригацияunclassified

International Alliance of Urolithiasis (IAU) guideline on retrograde intrarenal surgery (Russian adaptation)

Zeng,

Traxer,

Zhong

et al. 2024

Vestn. Urol.

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Introduction. The emergence of new scientiﬁc and clinical evidence on the use of retrograde intrarenal surgery (RIRS) for the management of kidney stones has prompted periodic systematisation, analysis, and evaluation of outcomes to standardise its application and determine future directions for research and development.Objective. To present the Russian adaptation of a guideline on retrograde intrarenal surgery from the International Urolithiasis Alliance guideline series to provide a theoretical basis for urologists performing RIRS.Materials & Methods. A systematic review was conducted on the RIRS-associated publications available in the PubMed database to prepare a set of recommendations during the period from 1 January 1964 until 1 October 2021. The recommendations were evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system, which classiﬁes, evaluates, develops, and examines recommendations. The modiﬁed Oxford Centre for Evidence-Based Medicine's (OCEBM) system for categorising the level of evidence and relevant comments have been applied to assess the strength of the conclusions.Results. The research team conducted a comprehensive analysis of 36 published clinical guidelines on the following topics: 1. Indications and Contraindications 2. Preoperative Imaging 3. Preoperative Ureteral Stenting 4. Preoperative Medications 5. Perioperative Use of Antibiotics 6. Use of Antithrombotic Therapy 7. Anesthesia Issues 8. Intraoperative Positioning 9. Equipment 10. Complications.Conclusion. A series of recommendations for RIRS, oﬀered here should help provide safe and eﬀective performance of RIRS.

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Prospective Randomized Comparison of Standard Hand Pump Infuser Irrigation vs an Automated Irrigation Pump During Percutaneous Nephrolithotomy and Ureteroscopy: Assessment of Operating Room Efficiency and Surgeon Satisfaction

Cited by 8 publications

References 21 publications

Ureteroscopic Techniques and Anatomic Sites Associated with Periods of Elevated Intrarenal Pressure

Ureteroscopic Techniques and Anatomic Sites Associated with Periods of Elevated Intrarenal Pressure

Under pressure: irrigation practice patterns during flexible ureteroscopy

International Alliance of Urolithiasis (IAU) guideline on retrograde intrarenal surgery (Russian adaptation)

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