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Comparison of intrarenal pressure between convention and vacuum-assisted ureteral access sheath using an ex vivo porcine kidney model

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Abstract

Objective

This study aimed to prove the vacuum-assisted ureteral access sheath (vaUAS) is more effective in maintaining a lower IRP than conventional ureteral access sheath (cUAS).

Materials

The model consisted of 12 freshly harvested adult porcine kidneys.

Methods

Either a 12/14F cUAS or vaUAS was alternately inserted into the ureter to one cm below the renal pelvis. Upper, middle, and lower calyces were punctured, and 6F pressure monitor catheters were introduced. IRP with cUAS was monitored using various irrigation rates. IRP with vaUAS was monitored with the same irrigation rates; various aspiration pressures; and vent fully closed, 50% closed, and fully open.

Results

cUAS with irrigation rate of 50 cc/min resulted in IRP < 30 mmHg. 50 to 100 cc/min should be used with caution. When irrigation rate exceeded 100 cc/min, IRP rose to ≥ 30 mmHg in most instances. With vent closed, vaUAS with vacuum pressure ≥ 150 mmHg and irrigation rate of 50 cc, 100 cc, and 150 cc/min generally resulted in IRPs < 5 mmHg. With vent half closed, vaUAS with vacuum pressure ≥ 300 mmHg and irrigation rate of ≤ 100 cc/min avoided IRP > 30 mmHg. vaUAS with vent open showed limited advantages over cUAS.

Conclusion

vaUAS maintains lower IRP than cUAS under same parameters. Both vaUAS and cUAS can be used when irrigation is ≤ 50 cc/min vaUAS showed clear advantages over cUAS in maintaining lower pressure when irrigation rate is ≥ 100 cc/min.

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Acknowledgements

The authors want to thank Professor Shaw P. Wan, MD. for his input and editing the English for this manuscript.

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Author notes

  1. Dong Wang and Zhenyuan Han are first co-author.

Authors and Affiliations

  1. Department of Urology, The People’s Hospital of Huantai, Zibo City, Shandong, China

    Dong Wang, Zhenyuan Han, Yudong Bi & Gang Ma

  2. Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China

    Guibin Xu & Qianyi Hu

  3. Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China

    Haibo Xi

Authors
  1. Dong Wang
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  4. Gang Ma
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  5. Guibin Xu
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  7. Haibo Xi
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Contributions

HX designed the experiment and wrote the manuscript. DW and ZH performed the experiments and wrote the manuscript. YB and GM contributed to data collection. GX and QH did data analysis.

Corresponding author

Correspondence to Haibo Xi.

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Conflict of interest

The authors of this study disclose no conflicts of interest. There was no funded for this study.

Informed consent

This research used commercially acquired animal parts (porcine kidneys). There was no live animal involved. This research was reviewed and approved by the Institutional Ethics Committees of all the institutions involved in this study. None of the participating institutions has Animals Care and Use Committee.

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Wang, D., Han, Z., Bi, Y. et al. Comparison of intrarenal pressure between convention and vacuum-assisted ureteral access sheath using an ex vivo porcine kidney model. World J Urol 40, 3055–3060 (2022). https://doi.org/10.1007/s00345-022-04149-2

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  • DOI: https://doi.org/10.1007/s00345-022-04149-2

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