Presentation Authors: Jonathan Wagmaister*, Neel H. Patel, Cristina Fox, Sean Fullerton, John L. Phillips, Majid Eshghi, Valhalla, NY
Introduction: Ureteroscopy for renal and ureteral stone disease is a low-risk procedure with minimal risks of serious complications, however, the rate of postoperative sepsis can be as high as 5%. High Renal Pelvic Pressure (RPP) with subsequent pyelovenous backflow and bacterial translocation into the renal parenchyma is considered one of the most significant risk factors. In this study, we present a technique in which the renal pelvis is continuously decompressed during ureteroscopy as a proposed method for reducing the operative RPP and the postoperative septic complications.
Methods: Technique: A flexible ureteroscope is safely positioned in the ureter and a parallel safety guidewire is exchanged for a 5 or a 6 French open-ended catheter, through which the renal pelvis can be passively or actively decompressed. Additionally, contrast medium can be injected for a simultaneous retrograde pyelogram, if indicated.Validation study: We have retrospectively reviewed the charts of our ureteroscopic procedures during the last 8 years in which the Continuous Renal Pelvic Decompression was implemented. The results were compared with the database of one of our satellite institutions, where the procedures were done under a regular technique. Both institutions implemented the same guideline-based perioperative prophylactic antibiotic protocols. Additionally, connecting the Arterial-line manometer to the ureteroscope, we have measured the RPP during our procedures.
Results: From 2010 to 2018 we have performed 721 ureteroscopic procedures with continuous renal decompression. No postoperative septic events were seen in any of these patients. In contrast, of 345 ureteroscopies performed in our satellite institution from 2010 to 2015, 15 (4.3%) ureteroscopy-related septic events were identified (p < 0.05). The RPP typically dropped from 140 to 60 mmHg range under continuous decompression.
Conclusions: The Continuous Renal Pelvic Decompression technique can contribute to reduce perioperative ureteroscopic infectious complications, allowing simultaneous retrograde contrast studies during lithotripsy. Additionally, it serves a practical way to actively decompress the collecting system, eliminating &[Prime]snow-storm effect&[Prime] and improving visibility, thus, potentially decreasing operating time.