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Intrarenal Pressure with Vacuum-Assisted Ureteral Access Sheaths Using an In Situ Cadaveric Porcine Model
Adam Ostergar1, Daniel Wong1, Alex Shiang1
1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
Journal of Endourology
|November 10, 2022
Summary
Vacuum-assisted ureteral access sheaths (V-UASs) lower intrarenal pressure during surgery. However, prolonged high suction can paradoxically increase pressure, suggesting short, low-suction bursts are optimal for V-UAS use.
Area of Science:
- Urology
- Surgical Technology
- Nephrology
Background:
- Vacuum-assisted ureteral access sheaths (V-UASs) are emerging tools for retrograde intrarenal surgery (RIRS).
- Potential benefits include improved stone-free rates, reduced infections, and shorter operative times.
- Optimal V-UAS settings and techniques require further investigation.
Purpose of the Study:
- To investigate real-time intrarenal pressure (IRP) during V-UAS use in a porcine RIRS model.
- To evaluate the impact of various V-UAS settings on IRP.
- To determine optimal V-UAS parameters for safe and effective use.
Main Methods:
- Ureteroscopy was performed in porcine kidneys using a ClearPetra V-UAS.
- IRP was monitored via a percutaneous catheter under varying inflow pressures, sheath sizes, distances from the ureteropelvic junction, and suction settings.
- Changes in IRP (dIRP) were analyzed across different conditions.
Main Results:
- V-UAS with suction significantly reduced mean IRP (from 42.30 to 24.45 mm Hg, p < 0.0001).
- Larger sheath size and lower irrigation pressures correlated with decreased IRP.
- Lower suction settings and short suction bursts (<5 seconds) were more effective than high vacuum (>200 mm Hg) in reducing IRP and avoiding paradoxical pressure increases.
Conclusions:
- V-UAS can effectively lower IRP during RIRS when used appropriately.
- Prolonged or high-intensity suction can lead to outflow tract collapse and paradoxical IRP elevation.
- Urologists should utilize lower suction settings and intermittent, short bursts to maximize V-UAS benefits and minimize risks.
