Session: MP23: Stone Disease: Surgical Therapy (including ESWL) I
MP23-17: Comparison of Intra Pelvic Pressure depended on Supine and Prone Position in Endoscopic Combined Intrarenal Surgery; Ex-Vivo Study of Porcine Kidney
Introduction: Intra pelvic pressure (IPP) over than 30 mmHg during endourological procedures for upper urinary tract stones is regarded as risk factor of postoperative fever and sepsis. Although endoscopic combined intrarenal surgery (ECIRS) has been currently developing, there is no evidence regarding with IPP during ECIRS by supine or prone position. We aimed to measure and compare the dynamic change of IPP in supine and prone position during ECIRS by using porcine kidney. Methods: We created the porcine kidney in which pressure sensor and 15/16F metal tract sheath were placed through renal capsule to renal collecting system, and the ureteral access sheath (UAS; 11/13F) was indwelled through the ureter. Prone position was defined as the tract was oriented upward at vertical position to the kidney. Supine position was defined as the tract was oriented downward at horizontal position to the kidney. 12F Nephroscope was inserted through metal tract with or without flexible ureteroscope (fURS) through UAS. Irrigation pressure of saline in nephroscope and fURS were controlled with the range of 40-160mmHg and 80cmH2O, respectively. On each position, we measured the dynamic change of IPP fifth times for 30 seconds in pure percutaneous nephrolithotomy (PCNL-group) with closed UAS, ECIRS with inserting fURS though UAS (fECIRS group), and ECIRS without fURS (non-fECIRS group) Results: In any of three groups, IPP in supine position was significantly lower than in prone position (p < 0.01). IPP in non-fECIRS group was significantly lower than in PCNL and fECIRS group in any position (p < 0.01). In addition, irrigation volume excreted from tract sheath and UAS was significantly larger in non-fECIRS group (p < 0.01). On the other hand, IPP in PCNL and fECIRS group almost changed equivalently. The threshold of antegrade irrigation pressure of saline which exceeds the 30mmHg IPP in PCNL and fECIRS group was 95mmHg under prone position, and 130mmHg under supine position. However, IPP in non-fECIRS group did not exceed over 30mmHg IPP in any position (Figure2). Conclusions: Supine position was lower IPP than prone position. Surprisingly, change of IPP in PCNL and fECIRS group demonstrated same dynamic state. Irrigation pressure might be required to set appropriately depending on kind of positions and procedures. SOURCE OF Funding: no
