How to Control Spikes in IRP during Flexible Ureterorenoscopy

For long, the two contradicting irrigation requirements during flexible ureterorenoscopy have been an Achilles heel for most surgeons. While large irrigation volumes are needed to achieve visibility, this can cause spikes in intrarenal pressure and lead to pyelovenous backflow, sepsis, and renal damage.

On the other hand, insufficient irrigation is often associated with poor visibility and potentially injurious temperatures when using high-powered lasers.

Intrarenal pressure is a function of the volume of fluid entering and exiting the kidney over time. Of course, in an ideal world, outflow would be equal to inflow, but in the real world, outflow is a lot less leaving the potential for spikes in intrarenal pressure.

Sounds like a complex puzzle to solve?

Worry not, because WE have two simple strategies to prevent spikes in intrarenal pressure.

By reducing the bolus size to 2-3ml. And by reducing baseline distension of the kidney by lowering the bag of liquid, which decompresses the kidney and allows for accommodation of a small bolus of irrigation. By keeping the kidney ¾ full, one is allowing it to admit volume without an increase in pressure. This, in combination with a smaller bolus size, prevents spikes in intrarenal pressure.

Peditrol, Wismed’s foot-operated irrigation system, has been designed to address this issue by delivering maximally 2.7ml, which is safer compared to larger volume devices.

While Mini Pillow, our hand-operated irrigation, can deliver maximally 3ml, which is only 30% of the kidney’s capacity.