MP29-09: The Magnetic Force: SRF Extraction in Living Porcine Models
Saturday, May 4, 2024 9:30 AM to 11:30 AM · 2 hr. (US/Central)
302B
Abstract
Information
Full Abstract and Figures
Author Block
Thomas Amiel*, Munich, Germany, Chiara Turrina, Shyam Srinivasan, Florian Ebel, Garching, Germany, Sami Fourati, Munich, Germany, Julian Häußler, Garching, Germany, Melanie Niebuhr, Robert Bischoff, Munich, Germany, Sebastian Schwaminger, Graz, Austria, Michael Straub, Munich, Germany
Introduction
According to the EAU Guidelines on Urolithiasis, the primary objective is the complete elimination of stones and achieving higher stone-clearance rates to minimize the likelihood of recurrence. In response to this challenge, we have introduced an innovative methodology utilizing a suspension of superparamagnetic iron oxide for the passive collection and removal of Small Residual Fragments (SRFs). This study seeks to assess the safety, tolerance, and feasibility of this system in a preclinical, in vivo setting using porcine models, with a view to justifying further clinical investigation.
Methods
This study involved five female pigs subjected to Retrograde Intrarenal Surgery (RIRS), with three control kidneys and seven treatment kidneys. In the control group, a "dust and go" approach was employed. In the treatment group, following stone dusting, the magnetic suspension was administered to magnetize and extract SRFs. Safety and tolerance were evaluated to detect potential adverse events and acute toxicity, complemented by clinical pathology, post-operative nephrectomy, and histopathology conducted by external, independent laboratories. The extraction time and the number of passages with the magnetic probe were meticulously recorded.
Results
The safety and tolerance assessments revealed an absence of adverse events or complications attributable to the treatment, i.e., the magnetic suspension and magnetic probe, suggesting an atraumatic nature of the system. Urothelial damage, characterized by desquamation and inflammation, was observed in all animals, primarily due to the insertion of access sheaths and laser lithotripsy. Residual iron oxide suspension was primarily found in the renal pelvis, with a smaller presence in the ureters, where they were predominantly free in the lumen. No vascular changes were detected in the kidneys or renal vein, and the renal papillae remained unaffected. There were no pathological indicators in urine and blood analyses. Overall, the treatment did not induce significant pathological changes. Quantification of residual SRFs was not feasible.
Conclusions
The preclinical in vivo assessment of magnetic SRF extraction in porcine kidneys demonstrates a promising, non-traumatic approach for SRF removal. It showcases both safety and feasibility, laying the foundation for further clinical investigations. This innovative method holds the potential to enhance stone-clearance rates with fewer passages and shorter extraction times, offering a fresh perspective in addressing the longstanding challenge of kidney stone disease in clinical practice.
Source Of Funding
Edith-Haberland-Wagner-Fund
Author Block
Thomas Amiel*, Munich, Germany, Chiara Turrina, Shyam Srinivasan, Florian Ebel, Garching, Germany, Sami Fourati, Munich, Germany, Julian Häußler, Garching, Germany, Melanie Niebuhr, Robert Bischoff, Munich, Germany, Sebastian Schwaminger, Graz, Austria, Michael Straub, Munich, Germany
Introduction
According to the EAU Guidelines on Urolithiasis, the primary objective is the complete elimination of stones and achieving higher stone-clearance rates to minimize the likelihood of recurrence. In response to this challenge, we have introduced an innovative methodology utilizing a suspension of superparamagnetic iron oxide for the passive collection and removal of Small Residual Fragments (SRFs). This study seeks to assess the safety, tolerance, and feasibility of this system in a preclinical, in vivo setting using porcine models, with a view to justifying further clinical investigation.
Methods
This study involved five female pigs subjected to Retrograde Intrarenal Surgery (RIRS), with three control kidneys and seven treatment kidneys. In the control group, a "dust and go" approach was employed. In the treatment group, following stone dusting, the magnetic suspension was administered to magnetize and extract SRFs. Safety and tolerance were evaluated to detect potential adverse events and acute toxicity, complemented by clinical pathology, post-operative nephrectomy, and histopathology conducted by external, independent laboratories. The extraction time and the number of passages with the magnetic probe were meticulously recorded.
Results
The safety and tolerance assessments revealed an absence of adverse events or complications attributable to the treatment, i.e., the magnetic suspension and magnetic probe, suggesting an atraumatic nature of the system. Urothelial damage, characterized by desquamation and inflammation, was observed in all animals, primarily due to the insertion of access sheaths and laser lithotripsy. Residual iron oxide suspension was primarily found in the renal pelvis, with a smaller presence in the ureters, where they were predominantly free in the lumen. No vascular changes were detected in the kidneys or renal vein, and the renal papillae remained unaffected. There were no pathological indicators in urine and blood analyses. Overall, the treatment did not induce significant pathological changes. Quantification of residual SRFs was not feasible.
Conclusions
The preclinical in vivo assessment of magnetic SRF extraction in porcine kidneys demonstrates a promising, non-traumatic approach for SRF removal. It showcases both safety and feasibility, laying the foundation for further clinical investigations. This innovative method holds the potential to enhance stone-clearance rates with fewer passages and shorter extraction times, offering a fresh perspective in addressing the longstanding challenge of kidney stone disease in clinical practice.
Source Of Funding
Edith-Haberland-Wagner-Fund