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Title: Pressurized-Bag Irrigation Versus Hand-Operated Irrigation Pumps During Ureteroscopic Laser Lithotripsy: Comparison of Infectious Complications.
Austin Authors: Farag, Matthew ;Timm, Brennan ;Davis, Niall;Wong, Lih-Ming ;Bolton, Damien M ;Jack, Gregory S 
Affiliation: Urology
Department of Urology, St Vincents Hospital, Melbourne, Australia
Department of Urology, Tallaght Hospital, Dublin, Ireland..
Issue Date: Sep-2020 2020-08-06
Publication information: Journal of Endourology 2020; 34(9): 914-918
Abstract: Introduction and Objectives: A variety of irrigation systems are available during ureteroscopy. We sought to compare gravity-driven pressure bags with hand-operated irrigation pumps in terms of postoperative complications after ureteroscopy with lithotripsy. Methods: A retrospective analysis of 234 patients undergoing flexible ureteropyeloscopy with laser lithotripsy by 24 supervised trainees over 4 years at a single teaching institution. Patients were divided into those who had procedures performed by using gravity-driven pressure bags fixed at 60 to 204 cm H2O, vs those who had procedures performed by using a hand-operated irrigation pump capable of delivering 1 to 10 mL per flush. Variables including surgical duration, hypotension, fever, sepsis, and hematuria were extracted from the charts, along with the surgical techniques utilized. Statistical analyses included chi-squared tests and Student's t-tests. Results: There were no differences in gender, age, indication, or stone size in the two groups. Postoperative systemic inflammatory response syndrome was significantly greater in the hand-assisted n = 11/144 (7.6%) compared with 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%) vs n = 12/90 (13%) in the pressure-bag irrigation, p = 0.002. Postoperative fever was also greater in the hand pump irrigation cohort compared with the continuous pressure cohort (13/144 [9%] vs 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 150 mmHg (204 cm H2O) or less may result in decreased pain, infection, and sepsis compared with handheld pressure irrigation.
DOI: 10.1089/end.2020.0148
PubMed URL: 32475171
Type: Journal Article
Subjects: intrarenal pressure
retrograde intrarenal surgery
Appears in Collections:Journal articles

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