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Dr. Munver on the importance of monitoring pressure during ureteroscopy


"The main advantage of the Lithovue Elite is that it allows for intrarenal and intraureteral pressure monitoring," says Ravi Munver, MD.

In this video, Ravi Munver, MD, discusses benefits of the Lithovue Elite, specifically highlighting the advantages of being able to monitor intrarenal pressure during ureteroscopy procedures. Munver is the vice chair of the department of urology at Hackensack University Medical Center (HUMC), as well as the director of minimally invasive and robotic urologic surgery, the chief of living donor kidney surgery, and the director of the minimally invasive robotic laparoscopic and reconstructive oncology fellowship program at HUMC in New Jersey.

Video Transcript:

This year, the Lithovue Elite was approved by the FDA. We started performing procedures with the Lithovue Elite, which is a second-generation single use disposable ureteroscope, in April of this year. The main advantage of the Lithovue Elite is that it allows for intrarenal and intraureteral pressure monitoring. Now, some people will say "why does that matter? I've been doing ureteroscopy for years and decades without monitoring pressure." Well, that's true. We have been doing this for years. But we've also been seeing patients who get septic after a ureteroscopy procedure in a setting of infected urine within the renal pelvis, within bacteria within the stone, or any infected urine or bacteria within the collecting system, especially when high irrigation pressures are used for the ureteroscopy procedure. Furthermore, patients with thin renal parenchyma or patients with hydronephrosis or chronic delitation of 1 or more calyces, they can have perforation of the calyces, they can have perinephric hematomas, they can have pyramidal hemorrhage, and they can have significant complications from high irrigation pressures that are being performed.

When we perform irrigation during ureteroscopy procedure, we can use either manual irrigation, so an assistant can manually irrigate, the surgeon himself or herself can manually irrigate, or we can use a pressure bag which will apply a fixed pressure, which can be adjusted to create enough pressure so that there's adequate visibility during the ureteroscopy procedure. The problem with this is that we do not know how much pressure we are applying. We may think that we're not irrigating too aggressively, and we may feel that, "okay, this is going to be fine," and then find out subsequently the patient has a complication, either a bleeding complication or a septic complication. Well, intrarenal and intraureteral pressure monitoring can be the solution.

What we have found in our early experience is that we have utilized a number of different techniques to see, can we create high or low pressures through manual irrigation or through using pressure bags through using ureteral access sheaths and through using different techniques at ureteroscopy. What our preliminary results have shown is that we have found techniques that we can use to minimize elevated pressures in the ureter and in the kidney itself. Hopefully, these techniques will lead to minimizing the risk for infection, which could lead to potential fatal sepsis, as well as bleeding complications and traumatic injury to the kidney.

This transcription has been edited for clarity.

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