Electromotive Drug Administration in the Porcine Ureter: First In Vivo A pplication for Ureteral Dilation - PubMed (original) (raw)

doi: 10.1177/08927790251383922. Epub 2026 Jan 18.

Yi Xi Wu 1, Seyed Hossein H Sharifi 2, Seyed Amiryaghoub M Lavasani 1, Seyedamirvala Saadat 1, Mark Sarwat Hana 1, Victor Pham 1, Erika Martinez-Carcamo 1, Olga Derbeneva 1, Aymon Ali 1, Zachary E Tano 1, Pengbo Jiang 1, Roshan M Patel 1, Jaime Landman 1, Ralph V Clayman 1

Affiliations

Electromotive Drug Administration in the Porcine Ureter: First In Vivo A pplication for Ureteral Dilation

Bruce M Gao et al. J Endourol. 2026 Jan.

Abstract

Objective: Retrograde intrarenal surgery is limited by the narrow caliber of the human ureter, resulting in both reluctance to deploy larger ureteral access sheaths and, at times, failed primary ureteral access, requiring placement of a ureteral stent and a delayed second procedure. In this study, we sought to evaluate the application of electromotive drug administration (EMDA) to deliver smooth muscle relaxants to the porcine ureter to facilitate acute ureteral dilation.

Methods: Eighteen juvenile female Yorkshire pigs were randomized into three treatment groups (alfuzosin, aminophylline, or isoproterenol; n = 6 per group). Within each animal, one ureter received an intraureteral drug infusion with EMDA, while the contralateral ureter served as a control, receiving 0.9% normal saline (NS). Ureteral size was assessed before and after treatment by passing sequentially larger urethral dilators starting at 10 Fr, with a maximum insertion force of 3.5 N.

Results: Only alfuzosin with EMDA increased ureteral size compared with NS alone (alfuzosin vs NS, 0.8 Fr vs 0.1 Fr, p = 0.031). Neither aminophylline nor isoproterenol with EMDA resulted in a significant increase in ureteral size compared with their respective NS controls (aminophylline vs NS, 0.3 Fr vs -0.6 Fr, p = 0.344; isoproterenol vs NS, 0.1 Fr vs -0.4 Fr, p = 0.125).

Conclusion: In this first report, EMDA-mediated in vivo delivery of alfuzosin into the porcine ureter acutely increased ureteral distensibility.

Keywords: electromotive drug administration; force sensor; surgical injury; ureteral access sheaths; ureteral dilation; ureteroscopy.

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Conflict of interest statement

Author Disclosure StatementJ.L. serves as Editor-in-Chief of the Journal of Endourology. The other authors declare no conflicts of interest.

Figures

Figure 1.

Figure 1.. The UCI Force Sensor.

Passage of a 14 Fr urethral dilator (Cook Medical, Bloomington, IN) over a guidewire with the UCI force sensor (left) with an example force reading (right).

Figure 2.

Figure 2.. Schematics of custom catheters for EMDA.

A. EMDA catheters fabricated by modifying the distal 20.0 cm section of 35 cm 13 Fr Navigator UAS 11 Fr obturators (Boston Scientific, Marlborough, MA) with equidistant 1.0 mm fenestrations placed 0.5 mm apart in three longitudinal rows. B. A three-way adaptor is connected to the proximal end of each EMDA catheter, allowing for simultaneous electromotive current generation, drug administration, and intrarenal pressure monitoring. C. Photograph of the distal portion and fenestrations of the EMDA catheter for the UUT.

Figure 3.

Figure 3.

A. Retrograde pyelogram of right porcine kidney and proximal ureter. B. Subsequent placement of the EMDA catheter in the right ureter and renal pelvis. Once the pure silver wire is advanced to the opening of the EMDA catheter, the insulated 0.5 mm tip on the distal end of the wire occludes the terminal end of the catheter, allowing for the distribution of medication through the side-hole fenestrations of the EMDA catheter.

Figure 4.

Figure 4.. Schematics of the in vivo experimental setup with EMDA in a female pig.

Bilateral EMDA catheters are positioned in the porcine ureters, with the distal ends terminating in the renal pelvis. On the control side (right), the EMDA catheter is only connected to an infusion of normal saline without EMDA. On the experimental side (left), the EMDA catheter is connected to an infusion of smooth muscle relaxant (alfuzosin, aminophylline, or isoproterenol) with pulsed direct current EMDA at 10 mA. Both sides are connected to a CVP line to maintain intra-renal pressure below 40 cm H2O.

Figure 5.

Figure 5.. Mean change in ureteral size (post-treatment to pre-treatment).

Treatment groups include alfuzosin, aminophylline, and isoproterenol with EMDA compared to the contralateral ureter with 0.9% sodium chloride infusion only.

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