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Assessing renal tissue temperature changes and perfusion effects during laser activation in an in vivo porcine model

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Abstract

Introduction

High fluid temperatures have been seen in both in vitro and in vivo studies with laser lithotripsy, yet the thermal distribution within the renal parenchyma has not been well characterized. Additionally, the heat-sink effect of vascular perfusion remains uncertain. Our objectives were twofold: first, to measure renal tissue temperatures in response to laser activation in a calyx, and second, to assess the effect of vascular perfusion on renal tissue temperatures.

Methods

Ureteroscopy was performed in three porcine subjects with a prototype ureteroscope containing a temperature sensor at its tip. A needle with four thermocouples was introduced percutaneously into a kidney with ultrasound guidance to allow temperature measurement in the renal medulla and cortex. Three trials of laser activation (40W) for 60 s were conducted with an irrigation rate of 8 ml/min at room temperature in each subject. After euthanasia, three trials were repeated without vascular perfusion in each subject.

Results

Substantial temperature elevation was observed in the renal medulla with thermal dose in two of nine trials exceeding threshold for tissue injury. The temperature decay time (t½) of the non-perfused trials was longer than in the perfused trials. The ratio of t½ between them was greater in the cortex than the medulla.

Conclusion

High-power laser settings (40W) can induce potentially injurious temperatures in the in vivo porcine kidney, particularly in the medullary region adjacent to the collecting system. Additionally, the influence of vascular perfusion in mitigating thermal risk in this susceptible area appears to be limited.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

Funding for this study was provided, in part, by a Faculty Catalyst Award, Department of Urology, University of Michigan, and, in part, by a research grant from Boston Scientific.

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Authors and Affiliations

  1. Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA

    Ron Marom, Julie J. Dau, Khurshid R. Ghani & William W. Roberts

  2. Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA

    Timothy L. Hall & William W. Roberts

Authors
  1. Ron Marom
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  2. Julie J. Dau
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  3. Khurshid R. Ghani
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  4. Timothy L. Hall
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  5. William W. Roberts
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Contributions

R Marom: Project development, Data Collection, Manuscript writing, Data analysis. WW Roberts: Manuscript writing/editing, Data analysis, Critical Revision, Study management. JJ Dau: Manuscript editing. KR Ghani: Manuscript editing. TL Hall: Manuscript editing.

Corresponding author

Correspondence to Ron Marom.

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Conflict of interest

K.R.G. has consulting relationships with Boston Scientific, Ambu, Olympus, Coloplast, and Karl Storz. W.W.R. has a consulting relationship with Boston Scientific. R.M., J.J.D., and T.L.H. have no disclosures.

Ethical approval

All procedures performed in the study involving animal subjects were in accordance with the ethical standards of the institutional research committee and were approved by the University of Michigan’s Institutional Animal Care and Use Committee (IACUC).

Disclaimer

The prototype ureteroscope used in this study was a concept device/technology, which was not available for sale at the time the study was conducted. Pre-clinical study results may not necessarily be indicative of clinical performance.

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Marom, R., Dau, J.J., Ghani, K.R. et al. Assessing renal tissue temperature changes and perfusion effects during laser activation in an in vivo porcine model. World J Urol 42, 197 (2024). https://doi.org/10.1007/s00345-024-04896-4

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  • DOI: https://doi.org/10.1007/s00345-024-04896-4

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