Presentation Authors: Akin S. Amasyali*, Mohammad Hajiha, Jason Groegler, Muhannad Alsyouf, Phillip Stokes, Williamson Le, Milan Shah, D. Duane Baldwin, Loma Linda, CA
Introduction: This study aims to compare the ability of 13 different commonly used urologic guidewires to bypass a tightly impacted ureteral stone.
Methods: We tested three stone impaction models using silicone ureters configured and mounted on a backboard bathed in saline. We created three degrees of impaction by placing cable ties above and below the stone at 300, 362, and 444 mgHg, and in all models we recorded the maximum force required to bypass the stone. In the first model (300 mmHg), ten different new 0.038 straight-tipped guidewires of 13 different types were advanced past a ureteral stone using a Series 5 digital force gauge. In the second model (362 mmHg), the top 5 performing guidewires were similarly tested using ten trials for each wire type. In the third model (444 mmHg), 5 attending urologists and 5 urology residents performed three trials with each of the 13 guidewire types. Participants rated their subjective preference of the guidewire using a Likert scale (1 to 5). Statistical analysis was performed with ANOVA and the Mann-Whitney U test.
Results: In the first model, the Glidewire and HiWire passed the impacted stone with the lowest mean force (p < 0.001:Table 1). Of the 5 wires tested in the second model (Glidewire, Zipwire, Hiwire, Solo Hydro and Ultratrack), the Glidewire required less force to bypass the impacted stone (Figure 1) than the other wires tested (Figure 1). In the third trial, only two wires (Glidewire and Roadrunner) bypassed the impacted stone in 100% of trials. The Glidewire had a lower time for wire passage (p < 0.01) and had the highest subjective surgeon rating (p < 0.01).
Conclusions: Significant differences exist between guidewire types in force required and ability to bypass an obstructing stone. In this bench-top study, the Glidewire required the least force, required the shortest insertion time, and had the highest surgeon satisfaction rating.
Source of Funding: Olympus