Impact of irrigation systems on stone migration.

Abstract:

PURPOSE:To evaluate forces exerted on a stone with different ureteroscopic irrigation systems that could impact stone migration during ureteroscopy. MATERIALS AND METHODS:A 3-mm steel simulated stone was welded to a 3F stone basket. The basket wire was then backloaded into the working channel of a 4.5F Wolf semirigid ureteroscope. The basket shaft was attached to a 50 g load cell. The ureteroscope was placed in a ureteral model (14F silicon tubing). Simulated blood was dripped adjacent to the stone at 12 drops/min. Endo-irrigation devices were attached to the ureteroscope, and irrigation was applied at a rate sufficient to maintain visualization of the stone. Force on the stone was measured with the following endo-irrigation systems: Gravity (183 cm H2O); pressurized irrigation (150 mm Hg, 300 mm Hg); Kosin Technology Universal Piggyback Irrigation System (UPIS) at gravity (183 cm H2O), 150 mm Hg and 300 mm Hg; EMS Medical Peditrol Foot Pump; Cook Ureteroscopy Irrigation System; ACMI Irri-Flo Irrigation Delivery System; and Boston Scientific Single-Action-Pump System (SAPS). RESULTS:SAP required the least number of pumps (0.35/sec) to maintain a clear endoscopic field while the Peditrol device required the most (1.88/sec). Pulse duration was longest for the ACMI (1.6 sec) and shortest for pressurized gravity and UPIS (<0.3 sec). The average total maximum impulse during a pump was significantly greater with the Cook (0.017 Ns) and ACMI (0.027 Ns) systems. On average, gravity-based systems applied the least amount of force, < or =0.0006 Ns, maximum impulse at any given time. CONCLUSIONS:Gravity-based systems exert less force than hand-held and foot-pump devices. Of the hand-held devices, the SAP exerted the least average maximum impulse on the stone.

journal_name

J Endourol

journal_title

Journal of endourology

authors

Hendlin K,Weiland D,Monga M

doi

10.1089/end.2007.0260

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

453-8

issue

3

eissn

0892-7790

issn

1557-900X

journal_volume

22

pub_type

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