Pressurized-bag irrigation versus hand-operated irrigation pumps during ureteroscopic laser lithotripsy: Comparison of infectious complications.

Abstract

Introduction & Objectives A variety of irrigation systems are available during ureteroscopy. We sought to compare gravity-driven pressure bags to hand-operated irrigation pumps; our primary outcome was post-operative infectious complications and secondary outcomes include unplanned re-admissions and emergency presentations. Methods A retrospective analysis of 234 patients undergoing flexible ureteropyeloscopy with laser lithotripsy by 24 supervised trainees over 6 years at a single teaching institution. Patients were divided into those who had procedures performed using gravity driven pressure bags fixed at 60-150 cmH20, versus those who had procedures using a hand operated irrigation pump capable of delivering 1-10mL per flush. Variables including surgical duration, hypotension, fever, sepsis, and haematuria were extracted from the charts, along with the surgical techniques and equipment utilised. Results There was no differences in gender, age, indication, or stone size in the two groups. Post-operative SIRS was significantly greater in the hand-assisted n=11/144 (7.6%) compared to the fixed irrigation group n=1/90 (1.1%); p= 0.032. Emergency room presentations were greater in the hand irrigation group n=46/144 (32%) versus n=12/90 (13%) in the pressure-bag irrigation, p= 0.002. Post-operative fever was also greater in the manual irrigation cohort compared to the continuous pressure cohort (13/144 (9%) versus 1/90 (1%), p= 0.011). No statistical difference was found between the two groups with respect to stone clearance and subsequent procedures required (p=0.123). Conclusions: This analysis suggests that using continuous flow irrigation at a fixed maximum pressure of 150mmHg (204 cmH20) or less may result in decreased pain, infection, and sepsis compared to hand-held pressure irrigation.