Does Continuous Intrarenal Pressure Predict Post-Ureteroscopy Sepsis? A Novel Pilot Study

Area of Science:

• Urology
• Nephrology
• Sepsis Research

Background:

• Postoperative sepsis is a recognized complication following ureteroscopy.
• The role of intrarenal pressure (IRP) in predicting postoperative sepsis remains under investigation.
• Pyelovenous backflow is hypothesized to occur at pressures exceeding 30 mmHg, yet IRP is not routinely monitored.

Purpose of the Study:

• To investigate the relationship between intrarenal pressure (IRP) during ureteroscopy and the occurrence of postoperative sepsis.
• To determine if IRP measurements can serve as a predictive marker for sepsis after ureteroscopy procedures.

Main Methods:

• A pilot study involving 100 patients undergoing ureteroscopy for kidney stones.
• Continuous measurement of intrarenal pressure (IRP) using the COMET™ II Pressure Guidewire.
• Analysis of IRP data across three phases: baseline, post-access sheath placement, and stone treatment, using statistical methods including ANOVA and odds/risk ratios.

Main Results:

• Patients who developed postoperative sepsis exhibited significantly higher median baseline and treatment phase IRP compared to those who did not.
• An intrarenal pressure (IRP) above 30 mmHg was associated with doubled odds and risk of sepsis, though not statistically significant.
• The 30 mmHg threshold demonstrated high specificity (0.93) and negative predictive value (0.89) for sepsis prediction at baseline, but low sensitivity (0.17).

Conclusions:

• Baseline intrarenal pressure (IRP) emerged as a significant predictor of sepsis following ureteroscopy for nephrolithiasis.
• Continuous IRP monitoring during ureteroscopy may offer a valuable tool for predicting sepsis risk.
• These findings open new research directions for sepsis prevention and management in urological procedures.