Safe use of hand operated irrigation devices during ureterorenoscopy

We have established best practices on the safe use of hand operated irrigation devices during flexible uretereorenoscopy, based on years of experience, research and innovation.

How to achieve best visibility without increase in intrarenal pressure?

Suspend the bag of liquid not more than 30 - 40 cm above the level of the patient to avoid constant distension of the kidney from hydrostatic pressure.

Remove air from the device by flushing it in the upright position.

Use small boluses of 1 -2 ml at a time to prevent high peaks in intrapelvic pressure. A good comparison is half of a teaspoon (2 ml) as the renal pelvis capacity is only 10ml.

Mini Pillow

Allow time between bolus delivery so drainage from the kidney can take place. It takes about 3 seconds for the intrarenal pressure to return to baseline after a single bolus delivery.

Use the shortest possible Ureteric Access Sheath and avoid the Trendelenburg position as it increases intrarenal pressure.

Bleeding is frequently a symptom of torn capillaries and increasing pressure by elevating the bag of liquid or delivering boluses more vigorously will worsen the situation. Bleeding can be prevented by working with lower pressures in the collecting system.

Hand-held irrigation devices should not be used with forced, constant flow-generating pumps (electric or pneumatic).

Smart Bulb