High pressure endoscopic irrigation: impact on renal histology
Int. braz. j. urol
;
47(2): 350-356, Mar.-Apr. 2021. tab, graf
Article
in English
| LILACS
| ID: biblio-1154451
ABSTRACT
ABSTRACT Purpose:
High intra-renal pressures during flexible ureteroscopy have been associated with adverse renal tissue changes as well as pyelovenous backflow. Our objective was to investigate the effect of various intra-renal pressures on histologic changes and fluid extravasation during simulated ureteroscopy. Materials andMethods:
Twenty-four juvenile pig kidneys with intact ureters were cannulated with an Olympus flexible ureteroscope with and without a ureteral access sheath and subjected to India ink-infused saline irrigation for 30 minutes at constant pressures ranging from sphygmomanometer settings of 50mm, 100mm and 200mmHg. Renal tissue samples were collected, processed and stained, and were evaluated by a blinded pathologist for depth of ink penetration into renal parenchyma as a percentage of total parenchymal thickness from urothelium to renal capsule.Results:
The mean percentage of tissue penetration for kidneys with ink present in the cortical tubules at sphygmomanometer pressure settings of 50, 100, and 200mm Hg without a ureteral access sheath was 33.1, 31.0 and 99.3%, respectively and with ureteral access sheath was 0, 0 and 18.8%, respectively. Overall, kidneys with an access sheath demonstrated a smaller mean tissue penetration among all pressure compared to kidneys without a sheath (6.3% vs. 54.5%, p=0.0354). Of kidneys with sheath placement, 11% demonstrated any ink compared to 56% of kidneys without sheath placement.Conclusions:
Pressurized endoscopic irrigation leads to significant extravasation of fluid into the renal parenchyma. Higher intra-renal pressures were associated with increased penetration of irrigant during ureteroscopy in an ex-vivo porcine model.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Ureter
/
Ureteroscopes
Limits:
Animals
Language:
English
Journal:
Int. braz. j. urol
Journal subject:
Urology
Year:
2021
Type:
Article
Affiliation country:
United States
Institution/Affiliation country:
Glickman Urological and Kidney Institute Cleveland Clinic Foundation/US
/
University of Washington Medical Center/US
/
Urology/US
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