Prospective Randomized Trial Comparing the Safety and Clarity of Water Versus Saline Irrigant in Ureteroscopy

Pirani, Farha; Makhani, Salima; Kim, Frances Y; Lay, Aaron; Cimmino, Cara; Hartsell, Lindsey; Spence, Ashley; Master, Viraj A.; Ogan, Kenneth

doi:10.1016/j.euf.2020.02.009

Cited by 5 publications

(2 citation statements)

References 16 publications

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“…Similarly, in a prospective, randomized and double-blinded study from the same institution, Pirani et al compared the visual clarity of sterile water with isotonic saline by subjective surgeon scores and turbidimeter analysis during URS. In this study, the authors used turbidimeter to measure fluid cloudiness in samples obtained from the renal pelvis and concluded that using sterile water is safe during URS, in addition to its visual superiority to isotonic saline [ 6 ]. Although turbidimetry objectively measures the particle rate of the water, alone it is not a sufficient method for comparing image clarity for URS.…”

Section: Discussionmentioning

confidence: 99%

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison

Ulker

Gulerce

Çelik

et al. 2020

Cent european J Urol

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Introduction Saline solution is the standard irrigant used during ureteroscopy. However, there is an opinion that water has better visual clarity. We aimed to compare the visual clarities of saline, water, and 5% mannitol as an irrigant during ureteroscopy. Material and methods An in vitro model consisting of an irrigant-filled container and a fiberoptic flexible ureteroscope was designed. A 1951 USAF Resolution Test Target and color checker within irrigants were used to evaluate the clarity of vision. The visual clarity was compared for 0.9% saline, distilled water and 5% mannitol solution with screen resolution and color contrast. The tests were repeated after adding human blood (2/400 ml) and contrast (20/400 ml) to the irrigants. Results There was no significant difference in resolution values of three plain irrigants at a distance of 10 mm. However, when blood was added to the irrigants, a better resolution of 29.3% for water and 20.6% for mannitol was achieved compared to saline. At 20 mm of distance, it was observed that the difference was more pronounced in irrigants with blood. Water and mannitol had 55.6% and 37.1% better resolution than saline, respectively. In the color reproduction test, there was no significant difference in the three plain irrigants, however, water had better color contrast compared to the others. Conclusions Water and 5% mannitol did not provide a significant image clarity advantage compared to saline. However, when blood was added to the irrigants, water provided significantly better visual clarity compared to saline. The use of water during various clinical scenarios in flexible ureteroscopy should be further investigated.

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Section: Discussionmentioning

confidence: 99%

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison

Ulker

Gulerce

Çelik

et al. 2020

Cent european J Urol

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“…Although some studies demonstrated that irrigation with sterile water during endourological procedures can improve endoscopic vision [ 75 , 76 , 77 ], normal saline remains the preferred standard irrigation fluid as use of a non‐isotonic solution increases the risk of haemolysis, hyponatraemia, and heart failure if sufficient volume is absorbed [ 78 , 79 ].…”

Section: Guidelinementioning

confidence: 99%

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

et al. 2022

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To set out the second in a series of guidelines on the treatment of urolithiasis by the International Alliance of Urolithiasis that concerns retrograde intrarenal surgery (RIRS), with the aim of providing a clinical framework for urologists performing RIRS. Materials and MethodsAfter a comprehensive search of RIRS-related literature published between 1 January 1964 and 1 October 2021 from the PubMed database, systematic review and assessment were performed to inform a series of recommendations, which were graded using modified GRADE methodology. Additionally, quality of evidence was classified using a modification of the Oxford Centre for Evidence-Based Medicine Levels of Evidence system. Finally, related comments were provided. ResultsA total of 36 recommendations were developed and graded that covered the following topics: indications and contraindications; preoperative imaging; preoperative ureteric stenting; preoperative medications; peri-operative antibiotics; management of antithrombotic therapy; anaesthesia; patient positioning; equipment; lithotripsy; exit strategy; and complications. ConclusionThe series of recommendations regarding RIRS, along with the related commentary and supporting documentation, offered here should help provide safe and effective performance of RIRS.

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Re: Farha Pirani, Salima S. Makhani, Frances Y. Kim, et al. Prospective Randomized Trial Comparing the Safety and Clarity of Water Versus Saline Irrigant in Ureteroscopy. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2020.02.009

Ventimiglia

Doizi

Salonia

et al. 2021

European Urology Focus

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Prospective Randomized Trial Comparing the Safety and Clarity of Water Versus Saline Irrigant in Ureteroscopy

Cited by 5 publications

References 16 publications

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison

International Alliance of Urolithiasis guideline on retrograde intrarenal surgery

Re: Farha Pirani, Salima S. Makhani, Frances Y. Kim, et al. Prospective Randomized Trial Comparing the Safety and Clarity of Water Versus Saline Irrigant in Ureteroscopy. Eur Urol Focus. In press. https://doi.org/10.1016/j.euf.2020.02.009

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