The Splash Zone: Efficacy of Ureteroscopic Adapters in Containing Hazardous Leak

Ureteroscopic procedures pose a splash hazard to urologists from irrigant contaminated with urine, blood, or caustic substances, risking health and vision. While ureteroscopic adapters aim to minimize fluid leakage, their efficacy remains unstandardized, with high-pressure irrigation potentially generating hazardous spray. This study aimed to evaluate the potential for hazardous leak of various ureteroscopic adapters.

Six different ureteroscopic adapters were assessed while performing ureteroscopy through a tissue-realistic kidney and ureter model at various levels of pressurized saline generated via a pressure bag and a single-action pumping system (SAPS) with and without a stone basket in the working channel. Leaking was classified as a drip (non-projectile leakage), a spray (small-volume projectile leak), or a splash (large-volume projectile leak). Hazardous spray was defined as any projectile leakage. Ultraviolet fluorescent stain was instilled in the irrigation and utilized to measure the maximal spray distance from the surgeon.

The Gyrus Adjustable Biopsy Port Seal had the highest potential for splash, including at gravity. Other adapters that exhibited hazardous leakage include the Gyrus Blue Silicone Seal with a basket in place and the Merit Hemostasis Valve while under high pressure using SAPS. Only one valve demonstrated no leak under any simulated circumstances (the Medtronic Piton). The Cook Check-Flo Adapter and Boston Scientific Urolok II demonstrated nonhazardous leakage. In the second arm of the experiment, maximal spray distance using the Gyrus Adjustable Biopsy Port Seal was 14.4 feet.

Ureteroscopic adapter leakage can be variable among adapters, and surgeons should be aware of the hazardous potential for exposure.