Impact of Irrigation Systems on Stone Migration

To evaluate forces exerted on a stone with different ureteroscopic irrigation systems that could impact stone migration during ureteroscopy. A 3-mm steel simulated stone was welded to a 3F stone basket. The basket wire was then backloaded into the working channel of a 4.5F Wolf semirigid ureteroscope. The basket shaft was attached to a 50 g load cell. The ureteroscope was placed in a ureteral model (14F silicon tubing). Simulated blood was dripped adjacent to the stone at 12 drops/min. Endo-irrigation devices were attached to the ureteroscope, and irrigation was applied at a rate sufficient to maintain visualization of the stone. Force on the stone was measured with the following endo-irrigation systems: Gravity (183 cm H2O); pressurized irrigation (150 mm Hg, 300 mm Hg); Kosin Technology Universal Piggyback Irrigation System (UPIS) at gravity (183 cm H2O), 150 mm Hg and 300 mm Hg; EMS Medical Peditrol Foot Pump; Cook Ureteroscopy Irrigation System; ACMI Irri-Flo Irrigation Delivery System; and Boston Scientific Single-Action-Pump System (SAPS). SAP required the least number of pumps (0.35/sec) to maintain a clear endoscopic field while the Peditrol device required the most (1.88/sec). Pulse duration was longest for the ACMI (1.6 sec) and shortest for pressurized gravity and UPIS (