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PROSPECTIVE RANDOMISED TRIAL COMPARING THE BARD INLAY™ URETERIC STENT WITH THE BOSTON SCIENTIFIC POLARIS™ URETERIC STENT USING THE VALIDATED URETERIC STENT SYMPTOM QUESTIONNAIRE
145 PROSPECTIVE RANDOMISED TRIAL COMPARING THE BARD INLAY™ URETERIC STENT WITH THE BOSTON SCIENTIFIC POLARIS™ URETERIC STENT USING THE VALIDATED URETERIC STENT SYMPTOM QUESTIONNAIRE
146 LONG-TERM FOLLOW-UP OF SELF-EXPANDING METALLIC STENTS FOR TREATMENT OF URETERAL OBSTRUCTION Burgos F.J.1, Bueno G.1, Gonzalez R.1, Diaz Nicolas V.1, Pascual J.2 Hospital Ramon y Cajal - Universidad Alcala, Dept. of Urology, Madrid, Spain, 2Hospital Ramon y Cajal - Universidad Alcala, Dept. of Nephrology, Madrid, Spain
1
Davenport K., Kumar V., Collins J., Melotti R., Keeley F.X., Timoney A.G. Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom Introduction & Objectives: 7RVWXG\DQGFRPSDUHWKHHᚎHFWRIWZRGLᚎHUHQWLQGZHOOLQJXUHWHULF stents on patient symptoms and quality of life using the validated ureteric stent symptom TXHVWLRQQDLUH 8664 ,WLVQRZUHFRJQLVHGWKDWXUHWHULFVWHQWVFDXVHDUDQJHRIVLGHHᚎHFWV in the majority of patients. Much work has been carried out in an attempt to identify a stent material which will minimise these symptoms. The Bard Inlay™ stent would be the standard stent used in our institution. This stent has a lubricious coating allowing smooth insertion and FODLPVWRVRIWHQE\XSWRDWERG\WHPSHUDWXUH7KH3RODULVറVWHQWLVPDGHRISHUFXᚐH[® material and has a Hydroplus coating which is claimed to minimise bladder discomfort whilst enhancing ease of placement. Material & Methods: A total of 155 patients requiring stent insertion for obstructing stone disease or following ureteroscopy were recruited and randomised to receive either the Bard ,QOD\റRUWKH%RVWRQ6FLHQWLᚏF3RODULVറXUHWHULFVWHQW3DWLHQWVZHUHDVNHGWRFRPSOHWHWKH USSQ two weeks following stent insertion and again, one week after removal of the stent. 7KHKLJKHUWKHVFRUHWKHJUHDWHUWKHHᚎHFWRQWKDWKHDOWKGRPDLQ SDWLHQWVIHPDOHVDQG 66 males, completed and returned the questionnaires. 44 patients received the Inlay™ stent and 54 received the Polaris™ stent. The mean age of these patients was 54 yrs and 57 yrs respectively. Results: 7KHUHZHUHQRVLJQLᚏFDQWGLᚎHUHQFHVEHWZHHQWKHWZRJURXSVIRUDQ\RIWKHKHDOWK domains assessed. In both groups the total urinary symptom score was higher with the stent LQVLWX,QOD\റ YV 3RODULVറ YV RIWKH,QOD\റJURXSH[SHULHQFHGSDLQ (median pain score 26) with the stent in situ as compared with 94% of the Polaris™ group PHGLDQ SDLQ VFRUH 7KLV UHGXFHG WR 036 YV 036 IROORZLQJ VWHQW removal. The median total general health score was higher with the stent in situ but similar in both groups (14 vs. 17 as compared with 9 vs. 10). Of those patients denying an active sex life, 50% of the Inlay™ group and 47% of the Polaris™ group gave stent symptoms as the reason. RISDWLHQWVRXJKWKHOSIURPDKHDOWKSURIHVVLRQDOIRUVWHQWUHODWHGVLGHHᚎHFWVZKLOVWWKH VWHQWZDVLQVLWXRIWKH,QOD\റJURXSDQGRIWKH3RODULVറJURXS S 16 Conclusions: 8UHWHULFVWHQWVKDYHDVLJQLᚏFDQWLPSDFWRQSDWLHQWTXDOLW\RIOLIH8QIRUWXQDWHO\ WKLV SURVSHFWLYH UDQGRPLVHG WULDO KDV VKRZQ WKDW WKHVH WZR YHU\ GLᚎHUHQW XUHWHULF VWHQWV GHVLJQHGZLWKWKHVSHFLᚏFDLPRILPSURYLQJVLGHHᚎHFWVFRQWLQXHWRKDYHVLPLODUGHWULPHQWDO HᚎHFWVRQSDWLHQWTXDOLW\RIOLIH
Introduction & Objectives: Clasically the insertion of a double J catheter or a nephrostomy have been the treatments of choice to resolve ureteral obstruction in neoplasic or high surgical risk patients, who are not candidates for surgery. Self-expanding metallic stents are useful in the treatment of biliary or vascular stenosis. However, its use for treatment of ureteral obstruction is scarce and the follow-up periods reported short. The aim of the study is to analyze the long-term patency and complications of metallic ureteral stent for treatment of benign and malignant ureteral obstruction. Material & Methods: 7KLUW\ᚏYHSDWLHQWVZLWKH[WULQVLFXUHWHUDOREVWUXFWLRQZHUHWUHDWHGE\ implantation of a Nitinol ureteral stent. The aetiology was a benign condition in 26 patients NLGQH\ WUDQVSODQW UHFLSLHQWV ZLWK FKURQLF JUDIW G\VIXQFWLRQ DQG KLJK VXUJLFDO ULVN SDWLHQWV DQGDPDOLJQDQF\LQ SDWLHQWV UHFWXPFDVHVDQGEODGGHUSURVWDWHDQGFHUYL[ 2 cases respectively). The length of stenosis varied from 1,5 to 6 cm. The technique was performed antegrade in 21 patients and retrograde in 14. The stent diameter was 4 mm in WKHᚏUVWFDVHVDQGPPLQWKHODVWFDVHV7KHPHDQIROORZXSZDVPRQWKV ದ 120) for benign conditions and 11,6 months (5,4 – 69) for malignancies. The patency rate and complications are evaluated at the moment of death or the last clinical control. Results: For benign conditions: 54% (14/26) of the stents are patent, 19% (7/26) needed an additional double J for patency and 19% (5/26) were occluded. The failed patients were treated by ureteral extraanatomical bypass (2), kidney autotransplantation (1), QHSKURVWRP\ DQGXUHWHURQHRF\VWRVWRP\ $OOQHRSODVLFSDWLHQWVGLHG RIWKHPKDGDSDWHQWVWHQW QHHGHGDQGDGGLWLRQDOGRXEOH-IRUSDWHQF\DQG LQFDVHVWKHVWHQWIDLOHG$QHSKURVWRP\ FDVHV DQGDQH[WUDDQDWRPLFDOXUHWHUDOE\ pass were performed in the patients with a failed stent. Incrustation of the stent and urinary LQIHFWLRQZHUHSUHVHQWLQFDVHV UHVSHFWLYHO\ Conclusions: 6HOIH[SDQGLQJ PHWDOOLF VWHQWV DUH HᚎHFWLYH LQ PRUH WKDQ RI WKH patients to resolve ureteral obstruction in the long-term follow-up. The insertion of a double J catheter increases the patency to 67% and 76%, depending on the malignant or benign aetiology of stenosis respectively. Obstruction of the stent due to tumor growth or urothelial hyperplasia is the most common complication. The incidences of incrustation or infection are low.
147
148
EFFECT OF TAMSULOSIN IN PREVENTING URETERAL STENT– RELATED MORBIDITY: A PROSPECTIVE STUDY
URETEROSCOPIC MODIFICATION TO REDUCE INTRAURETERAL PRESSURE
Damiano R.1, Autorino R.2, De Sio M.2, Spiezia N.1, Palumbo I.M.1, D’Armiento M.2
Ditrolio J.V.1, Bhalla R.2
1
Cattedra di Urologia, Campus Universitario di Germaneto, Catanzaro, Italy, 2Cattedra di Urologia, Seconda Universita di Napoli, Napels, Italy
Introduction & Objectives: We conducted a prospective randomized VWXG\WRHYDOXDWHWKHHᚎHFWRIWDPVXORVLQLQLPSURYLQJV\PSWRPVDQG4R/ in patients with indwelling double pigtail ureteral stents, using both generic DQGVSHFLᚏFTXHVWLRQQDLUHV Material & Methods: We prospectively enrolled 75 patients (29 men, 46 ZRPHQ PHDQ DJH \U VXEPLWWHG WR XUHWHUDO VWHQW SRVLWLRQLQJ DQG DVVLJQHGWRRQHRIWKHWZRVWXG\JURXSV,QJURXS$ Q SDWLHQWVZHUH discharged home with a prescription of tamsulosin 0,4 mg once daily. In JURXS% Q SDWLHQWVUHFHLYHGQRDOSKDEORFNHU FRQWUROJURXS Results: 1 week after stent positioning (visit W1), the analysis of ureteral VWHQWV\PSWRPVTXHVWLRQQDLUHVKRZHGDVLJQLᚏFDQWZRUVHQLQJRIXULQDU\ V\PSWRPV YV S DQG SDLQ YV S LQ SDWLHQWVQRWUHFHLYLQJWDPVXORVLQ7KHUHZDVDOVRDVLJQLᚏFDQWGLᚎHUHQFH in mean visual analog score (VAS) of health scale between the two groups (p < 0.001) compared to the result obtained at four week evaluation (visit : 7KHSURSRUWLRQRISDWLHQWVUHSRUWLQJOHYHORUIRUWKHSDLQGLVFRPIRUW domain in quality of life (QoL) questionnaire from W4 to W1 varied between WKHWZRJURXSVLQDKLJKO\VWDWLVWLFDOO\VLJQLᚏFDQWPDQQHU S Conclusions: 2XU ᚏQGLQJV LQGLFDWH WKDW DGPLQLVWUDWLRQ RI WDPVXORVLQ KDVDSRVLWLYHHᚎHFWRQVWHQWUHODWHGXULQDU\V\PSWRPVDQG4R/)XUWKHU FOLQLFDOUHVHDUFKLQWKLVDUHDLVZDUUDQWHGWREHWWHUGHᚏQHWKHUROHRIDOSKD blockers in current clinical practice.
1
UMDNJ/New Jersey Medical School, Dept. of Surgery/Urology, Newark, United States of America, 2State University of New York/Stony Brook, Dept. of Urology, Stony Brook, United States of America Introduction & Objectives: 7KHSDWWHUQRIᚐRZDQGSUHVVXUHYDOXHVKDYHQRWEHHQ determined in the ureter during semi-rigid ureteroscopy, because of the endless YDULDEOHVLQWKHKXPDQXUHWHU:HSUHVHQWWKHᚏUVWLQYHVWLJDWLRQFKDUDFWHUL]LQJXUHWHUDO ᚐRZ DQG SUHVVXUH ZLWK D QRYHO 2O\PSXV VHPLULJLG XUHWHURVFRSH :$ ; ZLWK JURRYHV DW WKH DQG RಬFORFN SRVLWLRQV ZKHQ FRPSDUHG WR WKH VWDQGDUG 2O\PSXV semi-rigid ureteroscope (WA29042A). Material & Methods: 7ZR LQ YLWUR V\VWHPV ZHUH GHVLJQHG FRPSRVHG RI SDUWV Ureteroscopes: A standard 6.9 French semi-rigid ureteroscope was used as the FRQWURO DQG WKH PRGLᚏHG VHPLULJLG XUHWHURVFRSH KDG ELODWHUDO EDFN ᚐRZ JURRYHV DW WKH RಬFORFN DQG WKH RಬFORFN SRVLWLRQV ZKLFK EHJLQV DW WKH GLODWHG )UHQFK section of the shaft from 10-25 cm. Assembly: Each scope was assembled with a 50cc syringe locked to the scope. The perfusion pump utilized a 50 cc syringe and was set at 20cc/hr which was then connected to the bridge of the ureteroscope. Next WKHXUHWHURVFRSHZDVSODFHGLQWKHSXUHVLOLFRQHWXEHZLWKDQLQWHUQDOGLDPHWHURI PP7KHVFRSHVZHUHLQWURGXFHGLQWRWKHOXPHQIRUDGLVWDQFHRIFPDQGFP /HDNSRLQWZDVLGHQWLᚏHGZKHQZDWHUZDVVHHQEDFNᚐRZLQJDWWKHDUWLᚏFLDOXUHWHU ureteroscope interface. Results: 7KHDYHUDJHRIWKUHHFRQVHFXWLYHUHDGLQJVZHUHWDNHQDWWKHDQGWKH FP SRVLWLRQ RQ WKH DPRXQW RI ᚐXLG LQWURGXFHG LQWR WKH VFRSH ZKLOH WKH DUWLᚏFLDO XUHWHUZDVREVWUXFWHGDWFPGLVWDOWRWKHWLSRIWKHXUHWHURVFRSH7KHSURWRW\SH 2O\PSXVXUHWHURVFRSHKDGDUHGXFWLRQLQSUHVVXUHDWFPZKHQFRPSDUHG to the standard semi-rigid ureteroscope and more importantly when introduced to 16 FPWKHUHGXFWLRQLQSUHVVXUHZDV Conclusions: In this in-vitro model, ureteroscopy with the new prototype ureteroscope ZLWK JURRYHV ORFDWHG DW WKH DQG RಬFORFN SRVLWLRQV UHVXOWHG LQ D GHFUHDVH LQ luminal pressures when all factors were controlled. Utilization of dead space within a ureteroscope can enhance its performance and reduce intrarenal pressure without FRPSURPLVLQJWKHHᚑFLHQF\RUVWUXFWXUDOLQWHJULW\RIWKHLQVWUXPHQW
Eur Urol Suppl 2008;7(3):107
146 LONG-TERM FOLLOW-UP OF SELF-EXPANDING METALLIC STENTS FOR TREATMENT OF URETERAL OBSTRUCTION Burgos F.J.1, Bueno G.1, Gonzalez R.1, Diaz Nicolas V.1, Pascual J.2 Hospital Ramon y Cajal - Universidad Alcala, Dept. of Urology, Madrid, Spain, 2Hospital Ramon y Cajal - Universidad Alcala, Dept. of Nephrology, Madrid, Spain
1
Davenport K., Kumar V., Collins J., Melotti R., Keeley F.X., Timoney A.G. Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom Introduction & Objectives: 7RVWXG\DQGFRPSDUHWKHHᚎHFWRIWZRGLᚎHUHQWLQGZHOOLQJXUHWHULF stents on patient symptoms and quality of life using the validated ureteric stent symptom TXHVWLRQQDLUH 8664 ,WLVQRZUHFRJQLVHGWKDWXUHWHULFVWHQWVFDXVHDUDQJHRIVLGHHᚎHFWV in the majority of patients. Much work has been carried out in an attempt to identify a stent material which will minimise these symptoms. The Bard Inlay™ stent would be the standard stent used in our institution. This stent has a lubricious coating allowing smooth insertion and FODLPVWRVRIWHQE\XSWRDWERG\WHPSHUDWXUH7KH3RODULVറVWHQWLVPDGHRISHUFXᚐH[® material and has a Hydroplus coating which is claimed to minimise bladder discomfort whilst enhancing ease of placement. Material & Methods: A total of 155 patients requiring stent insertion for obstructing stone disease or following ureteroscopy were recruited and randomised to receive either the Bard ,QOD\റRUWKH%RVWRQ6FLHQWLᚏF3RODULVറXUHWHULFVWHQW3DWLHQWVZHUHDVNHGWRFRPSOHWHWKH USSQ two weeks following stent insertion and again, one week after removal of the stent. 7KHKLJKHUWKHVFRUHWKHJUHDWHUWKHHᚎHFWRQWKDWKHDOWKGRPDLQ SDWLHQWVIHPDOHVDQG 66 males, completed and returned the questionnaires. 44 patients received the Inlay™ stent and 54 received the Polaris™ stent. The mean age of these patients was 54 yrs and 57 yrs respectively. Results: 7KHUHZHUHQRVLJQLᚏFDQWGLᚎHUHQFHVEHWZHHQWKHWZRJURXSVIRUDQ\RIWKHKHDOWK domains assessed. In both groups the total urinary symptom score was higher with the stent LQVLWX,QOD\റ YV 3RODULVറ YV RIWKH,QOD\റJURXSH[SHULHQFHGSDLQ (median pain score 26) with the stent in situ as compared with 94% of the Polaris™ group PHGLDQ SDLQ VFRUH 7KLV UHGXFHG WR 036 YV 036 IROORZLQJ VWHQW removal. The median total general health score was higher with the stent in situ but similar in both groups (14 vs. 17 as compared with 9 vs. 10). Of those patients denying an active sex life, 50% of the Inlay™ group and 47% of the Polaris™ group gave stent symptoms as the reason. RISDWLHQWVRXJKWKHOSIURPDKHDOWKSURIHVVLRQDOIRUVWHQWUHODWHGVLGHHᚎHFWVZKLOVWWKH VWHQWZDVLQVLWXRIWKH,QOD\റJURXSDQGRIWKH3RODULVറJURXS S 16 Conclusions: 8UHWHULFVWHQWVKDYHDVLJQLᚏFDQWLPSDFWRQSDWLHQWTXDOLW\RIOLIH8QIRUWXQDWHO\ WKLV SURVSHFWLYH UDQGRPLVHG WULDO KDV VKRZQ WKDW WKHVH WZR YHU\ GLᚎHUHQW XUHWHULF VWHQWV GHVLJQHGZLWKWKHVSHFLᚏFDLPRILPSURYLQJVLGHHᚎHFWVFRQWLQXHWRKDYHVLPLODUGHWULPHQWDO HᚎHFWVRQSDWLHQWTXDOLW\RIOLIH
Introduction & Objectives: Clasically the insertion of a double J catheter or a nephrostomy have been the treatments of choice to resolve ureteral obstruction in neoplasic or high surgical risk patients, who are not candidates for surgery. Self-expanding metallic stents are useful in the treatment of biliary or vascular stenosis. However, its use for treatment of ureteral obstruction is scarce and the follow-up periods reported short. The aim of the study is to analyze the long-term patency and complications of metallic ureteral stent for treatment of benign and malignant ureteral obstruction. Material & Methods: 7KLUW\ᚏYHSDWLHQWVZLWKH[WULQVLFXUHWHUDOREVWUXFWLRQZHUHWUHDWHGE\ implantation of a Nitinol ureteral stent. The aetiology was a benign condition in 26 patients NLGQH\ WUDQVSODQW UHFLSLHQWV ZLWK FKURQLF JUDIW G\VIXQFWLRQ DQG KLJK VXUJLFDO ULVN SDWLHQWV DQGDPDOLJQDQF\LQ SDWLHQWV UHFWXPFDVHVDQGEODGGHUSURVWDWHDQGFHUYL[ 2 cases respectively). The length of stenosis varied from 1,5 to 6 cm. The technique was performed antegrade in 21 patients and retrograde in 14. The stent diameter was 4 mm in WKHᚏUVWFDVHVDQGPPLQWKHODVWFDVHV7KHPHDQIROORZXSZDVPRQWKV ದ 120) for benign conditions and 11,6 months (5,4 – 69) for malignancies. The patency rate and complications are evaluated at the moment of death or the last clinical control. Results: For benign conditions: 54% (14/26) of the stents are patent, 19% (7/26) needed an additional double J for patency and 19% (5/26) were occluded. The failed patients were treated by ureteral extraanatomical bypass (2), kidney autotransplantation (1), QHSKURVWRP\ DQGXUHWHURQHRF\VWRVWRP\ $OOQHRSODVLFSDWLHQWVGLHG RIWKHPKDGDSDWHQWVWHQW QHHGHGDQGDGGLWLRQDOGRXEOH-IRUSDWHQF\DQG LQFDVHVWKHVWHQWIDLOHG$QHSKURVWRP\ FDVHV DQGDQH[WUDDQDWRPLFDOXUHWHUDOE\ pass were performed in the patients with a failed stent. Incrustation of the stent and urinary LQIHFWLRQZHUHSUHVHQWLQFDVHV UHVSHFWLYHO\ Conclusions: 6HOIH[SDQGLQJ PHWDOOLF VWHQWV DUH HᚎHFWLYH LQ PRUH WKDQ RI WKH patients to resolve ureteral obstruction in the long-term follow-up. The insertion of a double J catheter increases the patency to 67% and 76%, depending on the malignant or benign aetiology of stenosis respectively. Obstruction of the stent due to tumor growth or urothelial hyperplasia is the most common complication. The incidences of incrustation or infection are low.
147
148
EFFECT OF TAMSULOSIN IN PREVENTING URETERAL STENT– RELATED MORBIDITY: A PROSPECTIVE STUDY
URETEROSCOPIC MODIFICATION TO REDUCE INTRAURETERAL PRESSURE
Damiano R.1, Autorino R.2, De Sio M.2, Spiezia N.1, Palumbo I.M.1, D’Armiento M.2
Ditrolio J.V.1, Bhalla R.2
1
Cattedra di Urologia, Campus Universitario di Germaneto, Catanzaro, Italy, 2Cattedra di Urologia, Seconda Universita di Napoli, Napels, Italy
Introduction & Objectives: We conducted a prospective randomized VWXG\WRHYDOXDWHWKHHᚎHFWRIWDPVXORVLQLQLPSURYLQJV\PSWRPVDQG4R/ in patients with indwelling double pigtail ureteral stents, using both generic DQGVSHFLᚏFTXHVWLRQQDLUHV Material & Methods: We prospectively enrolled 75 patients (29 men, 46 ZRPHQ PHDQ DJH \U VXEPLWWHG WR XUHWHUDO VWHQW SRVLWLRQLQJ DQG DVVLJQHGWRRQHRIWKHWZRVWXG\JURXSV,QJURXS$ Q SDWLHQWVZHUH discharged home with a prescription of tamsulosin 0,4 mg once daily. In JURXS% Q SDWLHQWVUHFHLYHGQRDOSKDEORFNHU FRQWUROJURXS Results: 1 week after stent positioning (visit W1), the analysis of ureteral VWHQWV\PSWRPVTXHVWLRQQDLUHVKRZHGDVLJQLᚏFDQWZRUVHQLQJRIXULQDU\ V\PSWRPV YV S DQG SDLQ YV S LQ SDWLHQWVQRWUHFHLYLQJWDPVXORVLQ7KHUHZDVDOVRDVLJQLᚏFDQWGLᚎHUHQFH in mean visual analog score (VAS) of health scale between the two groups (p < 0.001) compared to the result obtained at four week evaluation (visit : 7KHSURSRUWLRQRISDWLHQWVUHSRUWLQJOHYHORUIRUWKHSDLQGLVFRPIRUW domain in quality of life (QoL) questionnaire from W4 to W1 varied between WKHWZRJURXSVLQDKLJKO\VWDWLVWLFDOO\VLJQLᚏFDQWPDQQHU S Conclusions: 2XU ᚏQGLQJV LQGLFDWH WKDW DGPLQLVWUDWLRQ RI WDPVXORVLQ KDVDSRVLWLYHHᚎHFWRQVWHQWUHODWHGXULQDU\V\PSWRPVDQG4R/)XUWKHU FOLQLFDOUHVHDUFKLQWKLVDUHDLVZDUUDQWHGWREHWWHUGHᚏQHWKHUROHRIDOSKD blockers in current clinical practice.
1
UMDNJ/New Jersey Medical School, Dept. of Surgery/Urology, Newark, United States of America, 2State University of New York/Stony Brook, Dept. of Urology, Stony Brook, United States of America Introduction & Objectives: 7KHSDWWHUQRIᚐRZDQGSUHVVXUHYDOXHVKDYHQRWEHHQ determined in the ureter during semi-rigid ureteroscopy, because of the endless YDULDEOHVLQWKHKXPDQXUHWHU:HSUHVHQWWKHᚏUVWLQYHVWLJDWLRQFKDUDFWHUL]LQJXUHWHUDO ᚐRZ DQG SUHVVXUH ZLWK D QRYHO 2O\PSXV VHPLULJLG XUHWHURVFRSH :$ ; ZLWK JURRYHV DW WKH DQG RಬFORFN SRVLWLRQV ZKHQ FRPSDUHG WR WKH VWDQGDUG 2O\PSXV semi-rigid ureteroscope (WA29042A). Material & Methods: 7ZR LQ YLWUR V\VWHPV ZHUH GHVLJQHG FRPSRVHG RI SDUWV Ureteroscopes: A standard 6.9 French semi-rigid ureteroscope was used as the FRQWURO DQG WKH PRGLᚏHG VHPLULJLG XUHWHURVFRSH KDG ELODWHUDO EDFN ᚐRZ JURRYHV DW WKH RಬFORFN DQG WKH RಬFORFN SRVLWLRQV ZKLFK EHJLQV DW WKH GLODWHG )UHQFK section of the shaft from 10-25 cm. Assembly: Each scope was assembled with a 50cc syringe locked to the scope. The perfusion pump utilized a 50 cc syringe and was set at 20cc/hr which was then connected to the bridge of the ureteroscope. Next WKHXUHWHURVFRSHZDVSODFHGLQWKHSXUHVLOLFRQHWXEHZLWKDQLQWHUQDOGLDPHWHURI PP7KHVFRSHVZHUHLQWURGXFHGLQWRWKHOXPHQIRUDGLVWDQFHRIFPDQGFP /HDNSRLQWZDVLGHQWLᚏHGZKHQZDWHUZDVVHHQEDFNᚐRZLQJDWWKHDUWLᚏFLDOXUHWHU ureteroscope interface. Results: 7KHDYHUDJHRIWKUHHFRQVHFXWLYHUHDGLQJVZHUHWDNHQDWWKHDQGWKH FP SRVLWLRQ RQ WKH DPRXQW RI ᚐXLG LQWURGXFHG LQWR WKH VFRSH ZKLOH WKH DUWLᚏFLDO XUHWHUZDVREVWUXFWHGDWFPGLVWDOWRWKHWLSRIWKHXUHWHURVFRSH7KHSURWRW\SH 2O\PSXVXUHWHURVFRSHKDGDUHGXFWLRQLQSUHVVXUHDWFPZKHQFRPSDUHG to the standard semi-rigid ureteroscope and more importantly when introduced to 16 FPWKHUHGXFWLRQLQSUHVVXUHZDV Conclusions: In this in-vitro model, ureteroscopy with the new prototype ureteroscope ZLWK JURRYHV ORFDWHG DW WKH DQG RಬFORFN SRVLWLRQV UHVXOWHG LQ D GHFUHDVH LQ luminal pressures when all factors were controlled. Utilization of dead space within a ureteroscope can enhance its performance and reduce intrarenal pressure without FRPSURPLVLQJWKHHᚑFLHQF\RUVWUXFWXUDOLQWHJULW\RIWKHLQVWUXPHQW
Eur Urol Suppl 2008;7(3):107