Abstract
Purpose
To identify a threshold for intrarenal pressure (IRP), that if exceeded, will result in renal parenchymal damage. Herein, we attempt to identify an IRP threshold by subjecting in vivo porcine kidneys to various levels of extreme pressurized irrigation. Our objective was not to simulate ureteroscopy treatment, but to attempt identify a threshold of IRP injury.
Methods
Ten female pigs were intubated and sedated. The abdomen was opened; the ureters were isolated and incised. A LithoVue™ (Boston Scientific) ureteroscope was inserted. A 0-silk tie was then used to tie the ureter around the scope to create a closed system (to achieve a constant level of pressure). Real-time IRPs were measured using the Comet™ Pressure guidewire (Boston Scientific). Kidneys were exposed to pressurized, saline for 36 min (at control, 50, 100, 150 mmHg and higher pressures). Kidneys were then immediately harvested. Two expert histologists independently analyzed kidney slides to identify areas of renal damage.
Results
The two kidneys exposed to IRPs > 185 mmHg resulted in forniceal rupture and large areas of hematoma. The other IRP groups (control, 50, 100, and 150 mmHg) had no identifiable gross or histologic renal parenchymal damage.
Conclusions
No differences in renal parenchymal morphology were identified between pressure groups of control, 50, 100, or 150 mmHg. However, IRPs > 185 mmHg did result in forniceal rupture in this closed-system in vivo porcine model. Further study is required to elucidate the damage threshold.
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This work was supported by a grant from Boston Scientific.
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MSL, BAC, JCW, and AEK contributed to project development, data collection, data analysis, and manuscript writing/editing. DKA contributed to project development, data collection, and data analysis. MAA contributed to project development and manuscript writing/editing. TL contributed to project development, data collection, and manuscript writing/editing.
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Dr. Amy Krambeck is a consultant for Ambu, Boston Scientific, Lumenis, Karl Storz, and Virtuoso Surgical. She is a board member of Sonomotion.
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This research was approved by the Indiana University School of Medicine Institutional Animal Care and Use Committee.
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Lee, M.S., Connors, B.A., Agarwal, D.K. et al. Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model. World J Urol 40, 2675–2681 (2022). https://doi.org/10.1007/s00345-022-04154-5
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DOI: https://doi.org/10.1007/s00345-022-04154-5