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The Positive Pressure Catheter for Measurement of Intracavital Pressures and Pressure Patterns
Vol. 98, Dec. Printed in U.S.A..
THE JOURNAL OF UROLOGY
Copyright © 1968 by The Williams & Wilkins Co.
THE POSITIVE PRESSURE CATHETER :FOR MEASUREMEKT OF IKTRACAVITAL PRESSURES AND PRESSURE PATTERKS ROBERT G. WEA YER
AND
JA:VIES J. YELDERMAN
From the Division of Urology, University of Utah College of J1Icclicine, Salt Lake City, Utah
The present catheter is an adaptation of this one and has been used with considerable success in detailed studies of ureteral peristaltic pressures and patterns. 4 It is adaptable for many different organ systems, although this particular design has been used specifically for ureteral catheterization and measurements in the mid and upper urinary tract.
The m.easurement of normal and abnormal activity within the cavities of many organs is providing a relatively new approach to some difficult diagnostic problems. The use of intracavital pressure recordings has increased markedly in the past 2 years and the potential application for this modality is still largely unexplored. A catheter for measuring such activity has been in the process of development for the past 5 years. It was observed that a distended renal pelvis would transmit intrarenal arterial pulse waves in the experimental animal and application of
CO"STRUCTION AND APPEARAKCE
The positive pressure catheter consists of 1 tube lying within another with each ending in a _.......-------
/
\LLOON INFLATED
y
_.......--------STOPCOCK LUER-LOK HUB FOR BALLOON INFLATION
,<, - - ~ - - - - ' - ' ~
\
WINGED LUER-LOK HUB FOR PRESSURE READINGS OR INJECTION SYRINGE
PRESSURE AND INJECTION PASSAGE
\_
CATHETER BODY DEPTH MARK!NGS LOCATED 5 CENTIMETERS APART
-WHISTLE TIP
Fm. 1. Construction of positive pressure catheter as it is supplied this phenomenon was made in patients with suspected renal vascular hypertension. 1 • 2 Enhorning perfected the first positive pressure catheter to measure two pressure patterns simultaneously, namely, the urethra and the bladder. 3 Accepted for publication January 19, 1967. Supported in part by National Institutes of Health Grant HE 08784-02. 1 Weaver, R. G.: Unpublished data. 2 Tanenbaum, H. L. and Kiser, W. S.: Transureteral hydros ta tic pressures and renal arterial pulse. Technic for the study of renal arterial occlusive disease. Amer. J. Cardiol., 13: 58-63, 1964. 3 Enhiirning, G. and Weaver, R. G.: Intraureteric pressure above and below an area of compression. Amer. J. Obst. & Gynec., 90: 1332-
1342, 1964.
separate arm. One tube, with a 2-way plastic stopcock, is used to inflate the balloon which lies 1.5 cm. distal to the tip. The other tube is used to transmit the column of fluid. It ends in a female Luer-Lok connection to enable the attachment of measurement devices (fig. 1). The catheter is composed of white polyvinyl plastic, 40 cm. long, and is available only in sizes 5 and 6 French, although a larger caliber should not present construction difficulties. Centimeter markings are made in increments of 5.0 cm. similar to standard plastic ureteral catheters (fig. 2). 4 Davis, D. M., Zimskind, P. D. and Paquet, J-P.: Studies on urodynamics: New light on ureteral function. J. Urol., 90: 150-159, 1963.
718
ME1\SUREMENT OF IXTRACAVI'.rAL PRESSURES AND PRESSURE PAT1'ER1\S
Fm. 2. Photograph of catheter shmvs centimeter markings and 2 arms, one for balloon inflation and pressure measurement takeoff.
1HJ
gauge. The balloon can be inflated and held at any reasonable degree of distension until enough to leased. It is, however, inflated gently occlude the ureter either completely or partially. There has been no difficulty in clef-la.ting the balloon or breaking of the tip of the catheter in more than 200 instillations into the: ureter and/or kidney The catheter can lie reused, in some cases up to 5 or 6 but it not advisable unless adequate facilitie~ for ga~ sterilization are available. It is doubtful that cold sterilization will give adequa,te proteetion cross infection in all cases. Pressure and peristalsis measuremenL8 iln)
Fm. 3. Catheter attached to strain gauge and portable recording apparatus. Actual recmdings of intrapelvic pressures are being made.
It was difficult in the construction of the original catheters to obtain a balloon which could be passed up the ureter with the same ease as a standard ureteral catheter. This and other mechanical problems have been surmounted with a resultant sturdy catheter and balloon.* APPLICATIOK AND us1,;s
Intrapelvic pressure patterns have been recorded in the laboratory and on clinical patients for the past year. The catheter transmits accurate pressures and is readily passed up the ureter transcystoscopically. No additional appliances are required to connect the catheter to the strain
* The Edwards Laboratories, 624 Dyer Road, Santa Ana, California, supplies the positive pressure catheter.
usually made with the patien under moderate sedation. The catheter is connteted to a. Stathmn strain gauge via a short length of standard in travenous infusion tubing. The latter is connectec1 to any standard amplifier and recording apparatus, either visual or written. The apparatus used in present work is an Ensco amplifier upon which is mounted a signal channel Tecbnic-Rdc 711 recorder. This compact of equipment, transmits a stable signal and is easy to (fig. 3). No increased ureteral spasm other than from an ordinary retrograde study is encounterccL Inulin clearance tests on pre- and of the ureter with these catheters showed no change in renal function in laboratory animals (dogs).
720
WEA VER AND YELDERiVIAN
CONCLUSIONS
Intrapelvic and intraureteral pressures and patterns is a diagnostic modality which is increasing in importance. A positive pressure catheter is available which can be readily passed up the ureter transcystoscopically. No reactions
in excess of those seen with other ureteral cathe terizations have been encountered in more than 200 measurements with these catheters. The staff of Edwards Laboratories offered counsel and experience in perfecting this equipment.
THE JOURNAL OF UROLOGY
Copyright © 1968 by The Williams & Wilkins Co.
THE POSITIVE PRESSURE CATHETER :FOR MEASUREMEKT OF IKTRACAVITAL PRESSURES AND PRESSURE PATTERKS ROBERT G. WEA YER
AND
JA:VIES J. YELDERMAN
From the Division of Urology, University of Utah College of J1Icclicine, Salt Lake City, Utah
The present catheter is an adaptation of this one and has been used with considerable success in detailed studies of ureteral peristaltic pressures and patterns. 4 It is adaptable for many different organ systems, although this particular design has been used specifically for ureteral catheterization and measurements in the mid and upper urinary tract.
The m.easurement of normal and abnormal activity within the cavities of many organs is providing a relatively new approach to some difficult diagnostic problems. The use of intracavital pressure recordings has increased markedly in the past 2 years and the potential application for this modality is still largely unexplored. A catheter for measuring such activity has been in the process of development for the past 5 years. It was observed that a distended renal pelvis would transmit intrarenal arterial pulse waves in the experimental animal and application of
CO"STRUCTION AND APPEARAKCE
The positive pressure catheter consists of 1 tube lying within another with each ending in a _.......-------
/
\LLOON INFLATED
y
_.......--------STOPCOCK LUER-LOK HUB FOR BALLOON INFLATION
,<, - - ~ - - - - ' - ' ~
\
WINGED LUER-LOK HUB FOR PRESSURE READINGS OR INJECTION SYRINGE
PRESSURE AND INJECTION PASSAGE
\_
CATHETER BODY DEPTH MARK!NGS LOCATED 5 CENTIMETERS APART
-WHISTLE TIP
Fm. 1. Construction of positive pressure catheter as it is supplied this phenomenon was made in patients with suspected renal vascular hypertension. 1 • 2 Enhorning perfected the first positive pressure catheter to measure two pressure patterns simultaneously, namely, the urethra and the bladder. 3 Accepted for publication January 19, 1967. Supported in part by National Institutes of Health Grant HE 08784-02. 1 Weaver, R. G.: Unpublished data. 2 Tanenbaum, H. L. and Kiser, W. S.: Transureteral hydros ta tic pressures and renal arterial pulse. Technic for the study of renal arterial occlusive disease. Amer. J. Cardiol., 13: 58-63, 1964. 3 Enhiirning, G. and Weaver, R. G.: Intraureteric pressure above and below an area of compression. Amer. J. Obst. & Gynec., 90: 1332-
1342, 1964.
separate arm. One tube, with a 2-way plastic stopcock, is used to inflate the balloon which lies 1.5 cm. distal to the tip. The other tube is used to transmit the column of fluid. It ends in a female Luer-Lok connection to enable the attachment of measurement devices (fig. 1). The catheter is composed of white polyvinyl plastic, 40 cm. long, and is available only in sizes 5 and 6 French, although a larger caliber should not present construction difficulties. Centimeter markings are made in increments of 5.0 cm. similar to standard plastic ureteral catheters (fig. 2). 4 Davis, D. M., Zimskind, P. D. and Paquet, J-P.: Studies on urodynamics: New light on ureteral function. J. Urol., 90: 150-159, 1963.
718
ME1\SUREMENT OF IXTRACAVI'.rAL PRESSURES AND PRESSURE PAT1'ER1\S
Fm. 2. Photograph of catheter shmvs centimeter markings and 2 arms, one for balloon inflation and pressure measurement takeoff.
1HJ
gauge. The balloon can be inflated and held at any reasonable degree of distension until enough to leased. It is, however, inflated gently occlude the ureter either completely or partially. There has been no difficulty in clef-la.ting the balloon or breaking of the tip of the catheter in more than 200 instillations into the: ureter and/or kidney The catheter can lie reused, in some cases up to 5 or 6 but it not advisable unless adequate facilitie~ for ga~ sterilization are available. It is doubtful that cold sterilization will give adequa,te proteetion cross infection in all cases. Pressure and peristalsis measuremenL8 iln)
Fm. 3. Catheter attached to strain gauge and portable recording apparatus. Actual recmdings of intrapelvic pressures are being made.
It was difficult in the construction of the original catheters to obtain a balloon which could be passed up the ureter with the same ease as a standard ureteral catheter. This and other mechanical problems have been surmounted with a resultant sturdy catheter and balloon.* APPLICATIOK AND us1,;s
Intrapelvic pressure patterns have been recorded in the laboratory and on clinical patients for the past year. The catheter transmits accurate pressures and is readily passed up the ureter transcystoscopically. No additional appliances are required to connect the catheter to the strain
* The Edwards Laboratories, 624 Dyer Road, Santa Ana, California, supplies the positive pressure catheter.
usually made with the patien under moderate sedation. The catheter is connteted to a. Stathmn strain gauge via a short length of standard in travenous infusion tubing. The latter is connectec1 to any standard amplifier and recording apparatus, either visual or written. The apparatus used in present work is an Ensco amplifier upon which is mounted a signal channel Tecbnic-Rdc 711 recorder. This compact of equipment, transmits a stable signal and is easy to (fig. 3). No increased ureteral spasm other than from an ordinary retrograde study is encounterccL Inulin clearance tests on pre- and of the ureter with these catheters showed no change in renal function in laboratory animals (dogs).
720
WEA VER AND YELDERiVIAN
CONCLUSIONS
Intrapelvic and intraureteral pressures and patterns is a diagnostic modality which is increasing in importance. A positive pressure catheter is available which can be readily passed up the ureter transcystoscopically. No reactions
in excess of those seen with other ureteral cathe terizations have been encountered in more than 200 measurements with these catheters. The staff of Edwards Laboratories offered counsel and experience in perfecting this equipment.