title: Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath.
abstract: OBJECTIVE
  To determine the differential effects on renal pressures and irrigation flow associated with the application of different ureteral catheters during percutaneous nephrolithotomy.
  
  
  METHODS
  Using ex vivo fresh cadaveric tissue, we established a percutaneous nephrolithotomy model. After obtaining lower pole percutaneous access, we recorded the pressure and irrigant flow measurements. Measurements were made with an empty ureter, 6F ureteral catheter, occlusion balloon catheter, and ureteral access sheaths (10/12F and 12/14F). Three 1-minute trials for each condition were recorded in each of four kidneys.
  
  
  RESULTS
  Ureteral catheterization with both the 10/12F and the 12/14F ureteral access sheaths resulted in significantly decreased intrarenal pressures in the pressure range tested compared with an empty ureter, a ureteral catheter, or an occlusion balloon application. Total irrigant flow for the 12/14F ureteral access sheath was significantly higher than for the empty ureter, ureteral catheter, or occlusion balloon in the entire pressure range evaluated.
  
  
  CONCLUSIONS
  In this in vitro cadaveric model, application of the ureteral access sheath during percutaneous nephrolithotomy resulted in decreased intrarenal pressures and increased irrigant flow.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
authors.forename: Maged
authors.initials: M
authors.lastname: Ragab
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Morrissey
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004867:Equipment Design; D006801:Humans; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D011312:Pressure; D012212:Rheology; D007507:Therapeutic Irrigation; D014513:Ureter / Q000502:physiology*; D014545:Urinary Calculi / Q000601:surgery; D014546:Urinary Catheterization / Q000295:instrumentation / Q000379:methods*