Dr. Allen discusses the growing focus on intrarenal pressure in ureteroscopy


“These are key, because right now our sepsis rates following ureteroscopy are, quite frankly, unacceptable,” says Jordan L. Allen, MD.

In this video, Jordan L. Allen, MD, discusses the increased focus on measuring intrarenal pressure during ureteroscopy. Allen is an endourologist at Allegheny Health Network and an assistant professor at Drexel College of Medicine in Pennsylvania.

Video Transcript:

We have a contract with Boston Scientific, and they're pushing the new LithoVue Elite. I think there's been a big shift in focus on measuring intrarenal pressures during ureteroscopy to reduce sepsis. In my practice, we switched over from the flexible reusable scopes and moved to the single use LithoVue scopes, and our sepsis rates are very low. I always use an access sheath too, to keep the pressures low, and I use a pressure bag so I can always control how high those internal pressures go. I've found sepsis rates are almost non-existent, like .1%, .2% since making those changes. I think the key is always drawing off all the fluid that's in the kidney immediately once you get up there, and then just keeping continuous flow through that sheath to prevent the pyelovenous backflow. [As] urologists, we tend to be stubborn in our ways. So, I think it'd be good to get that information out there, to show what those intrarenal pressures are.

The current LithoVue Elite models only tell you the pressures, they don't have the regulator at this point that will actually control the pressures, but that's on the horizon for them. I know a lot of people use hand irrigation when they're doing ureteroscopy. It's pretty remarkable to see how high those pressures can get with each spurt of that. They can reach over 300 centimeters water pressure, whereas if you have a pressure bag, you can set it at 150 and max it out. These are key, because right now our sepsis rates following ureteroscopy are, quite frankly, unacceptable. We've learned through the dogma of training in urology, that that's just part of the trade. But I think, from my practice, I've found that that doesn't have to be the case.

This transcription has been edited for clarity.

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