Does instrumentation and irrigation configuration affect intrarenal pressure during PCNL?

Area of Science:

• Urology
• Surgical Technology
• Medical Device Engineering

Background:

• Percutaneous nephrolithotomy (PCNL) involves managing intrarenal pressure (IRP).
• Varying configurations of nephroscope sheath, irrigation, and suction can impact IRP.
• Understanding these effects is vital for optimizing surgical safety and efficacy.

Purpose of the Study:

• To quantify the impact of different rigid nephroscope sheath (RNS), irrigation, instrument, and suction settings on IRP during simulated PCNL.
• To identify optimal configurations for maintaining low or temporarily elevated IRP.

Main Methods:

• Utilized 3D-printed kidney models simulating prone patient anatomy.
• Compared fourteen configurations of RNS, irrigation (inflow vs. outflow ports), and suction.
• Measured IRP retrogradely and analyzed data using Wilcoxon Signed-Rank test with Bonferroni correction.

Main Results:

• The RNS significantly increased mean IRP (19.1 vs. 14.7 mmHg; p < 0.001).
• Irrigation via the inflow port resulted in lower IRP (19.1 mmHg) than the outflow port (32.7 mmHg; p < 0.001).
• Suction significantly reduced IRP (p < 0.001), while instruments had no significant effect.

Conclusions:

• Low IRP is maintained by removing the RNS, using inflow irrigation, and employing suction.
• Elevated IRP can be achieved by using the outflow port for irrigation, minimizing drainage, and utilizing the RNS.
• These findings offer guidance for dynamic IRP management during PCNL.