Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath.
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.
Landman
Jaime
J
Division of Urology, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Venkatesh
Ramakrishna
R
Ragab
Maged
M
Rehman
Jamil
J
Lee
David I
DI
Morrissey
Kevin G
KG
Monga
Manoj
M
Sundaram
Chandru P
CP
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*