J Endourol 2020 Sep 6;34(9):914-918. Epub 2020 Aug 6.
Department of Urology, Austin Health, University of Melbourne, Melbourne, Australia.
A variety of irrigation systems are available during ureteroscopy. We sought to compare gravity-driven pressure bags with hand-operated irrigation pumps in terms of postoperative complications after ureteroscopy with lithotripsy. A retrospective analysis of 234 patients undergoing flexible ureteropyeloscopy with laser lithotripsy by 24 supervised trainees over 4 years at a single teaching institution. Patients were divided into those who had procedures performed by using gravity-driven pressure bags fixed at 60 to 204 cm HO, those who had procedures performed by using a hand-operated irrigation pump capable of delivering 1 to 10 mL per flush. Variables including surgical duration, hypotension, fever, sepsis, and hematuria were extracted from the charts, along with the surgical techniques utilized. Statistical analyses included chi-squared tests and Student's -tests. There were no differences in gender, age, indication, or stone size in the two groups. Postoperative systemic inflammatory response syndrome was significantly greater in the hand-assisted = 11/144 (7.6%) compared with the fixed irrigation group = 1/90 (1.1%); = 0.032. Emergency room presentations were greater in the hand irrigation group, = 46/144 (32%) = 12/90 (13%) in the pressure-bag irrigation, = 0.002. Postoperative fever was also greater in the hand pump irrigation cohort compared with the continuous pressure cohort (13/144 [9%] 1/90 [1%], = 0.011). No statistical difference was found between the two groups with respect to stone clearance and subsequent procedures required ( = 0.123). This analysis suggests that using continuous flow irrigation at a fixed maximum pressure of 150 mmHg (204 cm HO) or less may result in decreased pain, infection, and sepsis compared with handheld pressure irrigation.