Basic Science: Stones

Moderated Poster Session

MP2-5 - Comparison of intrarenal pelvic pressure levels during flexible ureteroscopy, mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy in a kidney model

Thursday, September 20
4:00 PM - 6:00 PM
Location: Room 242B

Introduction & Objective :

We aimed to compare intrarenal pelvic pressure (IPP) levels between flexible ureteroscopy (fURS), mini-PCNL and standard PCNL in a kidney model.


Methods :

A silicone model simulating the complete urinary tract was used for all the experiments. We compared fURS using a fURS with a 3.6-Fr working channel to mini-PCNL using a 12-Fr nephroscope with a 6.7-Fr working channel, and standard PCNL using a 26-Fr nephroscope. For the mini-PCNL, we used different sizes of operating sheaths: 15-Fr, 16.5-Fr and 21-Fr. For the standard PCNL, we used a 30-Fr operating sheath. We used an automated irrigation system to ensure a constant irrigation pressure. All the experiments were conducted at different instrument irrigation pressure levels: 40 cmH2O versus 193 cmH2O. We then compared the following parameters:
- fURS with and without ureteral access sheath, with empty working channel, and with 273 Âμm laser fiber
- Mini-PCNL with different sheath sizes; nephroscope with empty working channel and with 365 Âμm laser fiber
- Standard PCNL with 30-Fr access sheath, nephroscope with empty working channel, and with 11.4-Fr LithoClast Master lithotripter
Retrograde insertion of a PressureWire (St-Jude Medical, 0.014†wire) placed into the renal pelvis allowed for continuous IPP monitoring. We recorded the value of IPP (cm H2O) when reaching a plateau. Measurements were repeated 5 times and mean values of IPP were reported.


Results :

The IPP was constantly higher for fURS compared to mini- and standard PCNL at 40 and 193 cmH2O.
- fURS: Presence of UAS or 273 Âμm laser fiber in the working channel decreased the IPP proportionaly to the different levels of irrigation pressure. The lowest IPP was reached with combination of UAS and laser fiber at 40 cmH2O.
- Mini-PCNL: IPP was inversely proportional to the operating sheath at all levels of irrigation pressure. Presence of 365 Âμm laser fiber into the working channel did not affect IPP at 40 cmH2O except for the 15/16-Fr sheath where it decreased. Presence of laser fiber decreased IPP at 193 cmH2O.
- Standard PCNL: IPP did not change at 40 cm H2O even with LithoClast. IPP increased substantially at 193 cmH2O with LithoClast.


Conclusions : This study found that IPP was higher in fURS in all circumstances compared to mini- and standard PCNL.

Steeve S. Doizi

Urologist
Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France

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    Audrey Uzan

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      Etienne X. Keller

      Fellow of the ES
      Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, AP-HP, Hôpital Tenon, F-75020 Paris, France

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        Vincent De Coninck

        Urologist
        AZ Klina

        Vincent De Coninck graduated as a medical doctor from the Free University of Brussels, Belgium (VUB) in 2011. He became a certified urologist in 2017 after a training at the University Hospital of Brussels (Prof. Dr. Dirk Michielsen) and OLV Aalst (Prof. Dr. Alex Mottrie), where he developed a special interest in the minimal invasive treatment of benign and malignant pathologies. In the same year, he became Fellow of the European Board of Urology.
        In 2018, he completed a one-year fellowship program of the Endourological Society in Paris, France under the supervision of Prof. Dr. Olivier Traxer. During that fellowship, he also obtained a diploma in urolithiasis, organized by Dr. Michel Daudon at the Sorbonne University in Paris, France. Afterwards, he was trained in HoLEP by Dr. Karin Lehrich in Berlin, Germany.
        Currently, he is completing a three-month fellowship under the supervision of Dr. Guido Giusti in Milan, Italy. In December 2018, he will start working as an endourologist in AZ Klina, Brasschaat, Belgium. He will focus on the medical and surgical treatment of kidney stones and benign prostatic obstruction (HoLEP) and he will continue publishing articles relating to the management of patients with renal stone disease.

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          Maria Rodriguez-Monsalve Herrero

          Urologist
          University Hospital Puerta de Hierro, Majadahonda.

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            Olivier O. Traxer

            Professor
            Sorbonne Universite, GRC n020 Lithiase Renale, AP-HP, Hospital Tenon, F-75020 Paris, France

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              MP2-5 - Comparison of intrarenal pelvic pressure levels during flexible ureteroscopy, mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy in a kidney model



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