Intrarenal Pressure During Steerable Ureteroscopy Renal Evacuation by CVAC System Using Intrarenal Pressure...

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Steerable Ureteroscopic Renal Evacuation (SURE) is a novel technology using the CVAC system for enhanced renal stone clearance.
• Previous studies show SURE's promise for larger renal stones.
• Continuous intrarenal pressure (IRP) monitoring during ureteroscopy with laser lithotripsy and CVAC is crucial.

Purpose of the Study:

• To continuously monitor intrarenal pressure (IRP) during ureteroscopy with laser lithotripsy using the CVAC system and SURE technique.
• To evaluate the safety and efficacy of the SURE technique in managing renal stones.
• To identify IRP thresholds and management strategies during the procedure.

Main Methods:

• Prospective enrollment of patients undergoing ureteroscopic laser lithotripsy with the SURE technique.
• IRP measurement using a 5F Pollack catheter and a 12/14F ureteral access sheath.
• Real-time IRP recording every minute, with a defined threshold of 40 mm Hg.

Main Results:

• Simultaneous placement of access sheath and catheter was feasible in 52% of patients.
• Mean IRP was 17 mm Hg, with a maximum of 37 mm Hg.
• 100% stone clearance was achieved; transient IRP >40 mm Hg due to fragment occlusion resolved with a push-pull syringe maneuver.

Conclusions:

• The SURE technique achieves complete stone clearance while maintaining IRP within safe limits.
• IRP exceeding 40 mm Hg indicates clogs that are resolvable with the push-pull syringe maneuver.
• The SURE technique is a safe and effective alternative for moderate renal stone burdens.