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Huang X, He X, Zhai Q, Song L, Du C, Deng X. Ureteroscopic lithotripsy with pressure-measuring ureteral access sheath for large ureteral stones. MINIM INVASIV THER 2024; 33:157-162. [PMID: 38258834 DOI: 10.1080/13645706.2024.2306813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/30/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION To evaluate the safety and efficacy of ureteroscopic lithotripsy with pressure-measuring ureteral access sheath (PM-UAS) for large ureteral stones. MATERIAL AND METHODS A total of 258 consecutive patients with large ureteral stones ≥15 mm was enrolled. They were treated by ureteroscopic lithotripsy with PM-UAS in the oblique supine lithotomy position. The technology can precisely monitor and automatically control cavity pressure. The cavity pressure control value was set at -15 mmHg∼-5 mmHg. The cavity pressure limit value was set at 30 mmHg. Infusion flow rate was set at 100-200 ml/min. Postoperative data such as stone-free rate and complications were analyzed. RESULTS PM-UAS was successfully implanted in 225 patients at one stage. Eighteen cases of patients who had failed the first surgery were successfully treated with a second operation. Fifty-one cases with stones migrating up to the kidney were converted to flexible lithotripsy. The other 15 cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. The operative time was 49.5 ± 11.2 min. The stone-free rates after one month and three months were 87.2% (212/243) and 94.2% (229/243), respectively. Complications from grade I to II were observed in 25(10.3%) patients. No other complications from grade III to V were noted. CONCLUSION The ureteroscopic lithotripsy with PM-UAS is safe and efficacious for large ureteral stones.
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Affiliation(s)
- Xin Huang
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolong He
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Qiliang Zhai
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Chuance Du
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
| | - Xiaolin Deng
- Department of Urology, Ganzhou People's Hospital, Ganzhou, Jiangxi, China
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Deng X, Chen Y, Zhai Q, Song L, Du C, Tan W. Fluid absorption during flexible ureteroscopy with intelligent control of renal pelvic pressure: a randomized controlled trial. World J Urol 2024; 42:331. [PMID: 38758400 DOI: 10.1007/s00345-024-05036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/08/2024] [Indexed: 05/18/2024] Open
Abstract
PURPOSE To investigate fluid absorption and its influencing factors during flexible ureteroscopy with intelligent control of renal pelvic pressure (RPP). METHODS A total of 80 patients with upper urinary tract calculi underwent flexible ureteroscopy with intelligent control of RPP by pressure-measuring ureteral access sheath and were randomly divided into four groups. The RPP of Groups A, B, and C were set at - 5, 0 and 5 mmHg, respectively. Conventional flexible ureteroscopy with uncontrolled pressure served as control Group D. The perfusion flow rate was set at 100 ml/min in the four groups, with 20 patients in each group. The fluid absorption was measured by 1% ethanol every 10 min. Operation time, stone-free rate, and complications were recorded. RESULT Seventy-three patients were finally included in the RCT. The general and preoperative data of the patients were comparable between the groups. The fluid absorption of Groups A, B, and C was significantly less than that of Group D (P < 0.01). Fluid absorption and operation time were positively correlated, and the correlation coefficients R were 0.864, 0.896, 0.918, and 0.947, respectively (P < 0.01). The fluid absorption of patients with vomiting, fever and ureteral injury was greater than that of patients without complications in the four groups (P < 0.01). In different groups, fluid absorption was greater in patients with ureteral injury Post-Ureteroscopic Lesion Scale (PULS) 1-3 than in noninjured patients (P < 0.01). CONCLUSION Flexible ureteroscopy with intelligent control of RPP effectively reduces the absorption of perfusion fluid. Operation time and ureteral injury are also key factors affecting perfusion fluid absorption. REGISTRATION NUMBER AND DATE NCT05201599; August 11, 2021.
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Affiliation(s)
- Xiaolin Deng
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
- Jiangxi Inventor Technology Company Limited, Jiangxi, China
| | - Yijian Chen
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Qiliang Zhai
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Leming Song
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
- Jiangxi Inventor Technology Company Limited, Jiangxi, China
| | - Chuance Du
- Department of Urology, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, 17 Hongqi Avenue, Ganzhou City, 341000, Jiangxi Province, People's Republic of China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
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Bai J, Chi Y, Shangguan T, Lin J, Ye Y, Huang J, Wen Y, Liu R, Chen R, Cai W, Chen J. Intrarenal pressure detection during flexible ureteroscopy with fiber optic pressure sensor system in porcine model. Sci Rep 2024; 14:9446. [PMID: 38658694 PMCID: PMC11043377 DOI: 10.1038/s41598-024-60080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
To validate the feasibility of a fiber-optic pressure sensor-based pressure measurement device for monitoring intrarenal pressure and to analyze the effects of ureteral acess sheath (UAS) type, surgical location, perfusion flow rate, and measurement location on intrarenal pressure (IRP). The measurement deviations and response times to transient pressure changes were compared between a fiber-optic pressure sensing device and a urodynamic device IRP in an in vitro porcine kidney and in a water tank. Finally, pressure measurements were performed in anesthetized female pigs using fiber-optic pressure sensing device with different UAS, different perfusion flow rates, and different surgical positions at different renal calyces and ureteropelvic junctions (UPJ). According to our operation, the result is fiber optic pressure sensing devices are highly accurate and sensitive. Under the same conditions, IRP varied among different renal calyces and UPJ (P < 0.05). IRP was lowest at 50 ml/min and highest at 150 ml/min (P < 0.05). Surgical position had a significant effect on IRP (P < 0.05). 12/14 Fr UAS had a lower IRP than 11/13 Fr UAS. Therefore fiber optic pressure sensing devices are more advantageous for IRP measurements. In ureteroscopy, the type of ureteral sheath, the surgical position, the perfusion flow rate, and the location of the measurement all affect the intrarenal pressure value.
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Affiliation(s)
- Junjie Bai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yangjian Chi
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Tong Shangguan
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lin
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yushi Ye
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jianfeng Huang
- Department of Urology, Zhenghe County Hospital, Nanping, China
| | - Yahui Wen
- Department of Breast Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Liu
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ru Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weizhong Cai
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China.
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Farkouh A, Park K, Buell MI, Mack N, De Guzman C, Clark T, Baldwin EA, Shete K, Leu R, Amasyali AS, Seibly E, Cheng KW, Song S, Okhunov Z, Baldwin DD. Prone vs supine percutaneous nephrolithotomy: does position affect renal pelvic pressures? Urolithiasis 2024; 52:66. [PMID: 38630256 PMCID: PMC11023995 DOI: 10.1007/s00240-024-01555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
The purpose of this study was to measure and compare renal pelvic pressure (RPP) between prone and supine percutaneous nephrolithotomy (PCNL) in a benchtop model. Six identical silicone kidney models were placed into anatomically correct prone or supine torsos constructed from patient CT scans in the corresponding positions. A 30-Fr renal access sheath was placed in either the upper, middle, or lower pole calyx for both prone and supine positions. Two 9-mm BegoStones were placed in the respective calyx and RPPs were measured at baseline, irrigating with a rigid nephroscope, and irrigating with a flexible nephroscope. Five trials were conducted for each access in both prone and supine positions. The average baseline RPP in the prone position was significantly higher than the supine position (9.1 vs 2.7 mmHg; p < 0.001). Similarly, the average RPP in prone was significantly higher than supine when using both the rigid and flexible nephroscopes. When comparing RPPs for upper, middle, and lower pole access sites, there was no significant difference in pressures in either prone or supine positions (p > 0.05 for all). Overall, when combining all pressures at baseline and with irrigation, with all access sites and types of scopes, the mean RPP was significantly higher in the prone position compared to the supine position (14.0 vs 3.2 mmHg; p < 0.001). RPPs were significantly higher in the prone position compared to the supine position in all conditions tested. These differences in RPPs between prone and supine PCNL could in part explain the different clinical outcomes, including postoperative fever and stone-free rates.
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Affiliation(s)
- Ala'a Farkouh
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kyu Park
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Matthew I Buell
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Nicole Mack
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cliff De Guzman
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Toby Clark
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Elizabeth A Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kanha Shete
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Rose Leu
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Akin S Amasyali
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Evan Seibly
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Kai Wen Cheng
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Sikai Song
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - Zhamshid Okhunov
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Health, Room A560, 11234 Anderson Street, Loma Linda, CA, 92354, USA.
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Osther PJ, Osther SS. Understanding intrarenal backflow: Intrarenal pressure during ureteroscopy and beyond. Asian J Urol 2024; 11:139-142. [PMID: 38680595 PMCID: PMC11053329 DOI: 10.1016/j.ajur.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 05/01/2024] Open
Affiliation(s)
- Palle J.S. Osther
- Corresponding author. Urological Research Center, Department of Urology, Vejle Hospital (a part of Lillebaelt Hospital), University Hospital of Southern Denmark, Vejle, Denmark.
| | - Susanne S. Osther
- Urological Research Center, Department of Urology, Vejle Hospital (a part of Lillebaelt Hospital), University Hospital of Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Faure A, Paye Jaouen A, Demede D, Juricic M, Arnaud A, Garcia C, Charbonnier M, Abbo O, Botto N, Blanc T, Leclair MD, Loubersac T. Safety and feasability of ureteroscopy for pediatric stone, in children under 5Â Years (SFUPA 5): A French multicentric study. J Pediatr Urol 2024; 20:225.e1-225.e8. [PMID: 38030430 DOI: 10.1016/j.jpurol.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20Â mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. OBJECTIVE To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. STUDY DESIGN After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. RESULTS Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14Â Kg (6.3-23). Median stone size was 13Â mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91Â % procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2Â % for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2Â % of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. DISCUSSION Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. CONCLUSION URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.
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Affiliation(s)
- A Faure
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France.
| | - A Paye Jaouen
- APHP, Robert-Debré University Hospital, National Reference Center for Rare Urinary Tract Diseases "MARVU", Pediatric Urology, Paris, France
| | - D Demede
- University Hospital of Lyon, Pediatric Urology, Lyon, France
| | - M Juricic
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - A Arnaud
- University Hospital of Rennes, Pediatric Urology, Rennes, France
| | - C Garcia
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - M Charbonnier
- APHM, Aix Marseille University, Timone Enfants, Department of Pediatric Surgery, Marseille, France
| | - O Abbo
- University Hospital of Toulouse, Pediatric Urology, Toulouse, France
| | - N Botto
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Blanc
- Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France
| | - M D Leclair
- Nantes Université, Pediatric Urology, Nantes, France
| | - T Loubersac
- Nantes Université, Pediatric Urology, Nantes, France
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Shi J, Huang T, Song B, Liu W, Cheng Y, Fang L. The optimal ratio of endoscope-sheath diameter with negative-pressure ureteral access sheath: an in vitro research. World J Urol 2024; 42:122. [PMID: 38453696 DOI: 10.1007/s00345-024-04815-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/16/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE To maintain safe intrarenal pelvic pressure (IPP), the combination of flexible ureteroscope (fURS) and traditional ureteral access sheath (T-UAS) should maintain a basic rule that is the ratio of endoscope-sheath diameter (RESD) ≤ 0.75. However, the negative-pressure ureteral access sheath (NP-UAS) may break the rule of negative pressure suction. This study aimed to examine the effect of NP-UAS on IPP and flow rate (FR) with varying RESD. METHODS In a 3D-printed renal model, flexible ureteroscopy lithotripsy (fURL) was replicated. Six sizes of fURS paired with 12Fr T-UAS and NP-UAS resulted in six distinct RESDs of 0.63, 0.78, 0.87, 0.89, 0.90, and 0.91. While the irrigation pressure (IRP) was set between 100 and 800 cmH2O and the sucking pressure (SP) was set between 0 and 800 cmH2O, the IPP and FR were measured in each RESD. RESULTS NP-UASs can reduce the IPP and increase the FR at the same RESD compared to T-UASs. The IPP decreased with increasing SP with NP-UAS. When RESD ≤ 0.78, T-UAS and NP-UAS can maintain IPP < 40 cmH2O in most circumstances. When RESD = 0.87, it is challenging for T-UAS to sustain IPP < 40 cmH2O; however, NP-UAS can do so. When RESD ≥ 0.89, it is difficult to maintain an IPP < 40 cmH2O even with NP-UAS. CONCLUSION NP-UAS can decrease IPP and increase FR compared with T-UAS. To maintain a safe IPP, it is recommended that RESD < 0.85 when utilizing NP-UAS.
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Affiliation(s)
- Jingyu Shi
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China
| | - Ting Huang
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China
| | - Baiyang Song
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, China
| | - Wanzhang Liu
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China
| | - Yue Cheng
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China
| | - Li Fang
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59#, Liuting Street, Haishu District, Ningbo, 315000, Zhejiang, China.
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Yang Z, Song L, Huang Y, Chen H, Sun T. Experimental study of a new technique for minimally invasive percutaneous nephrolithotomy: intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy. BMC Surg 2024; 24:68. [PMID: 38388440 PMCID: PMC10882837 DOI: 10.1186/s12893-024-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 02/17/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND To test the reliability and safety of a newly invented technique for minimally invasive percutaneous nephrolithotomy, intelligent pressure-controlled minimally invasive percutaneous nephrolithotomy (IPC-MPCNL). METHODS Eighteen kidneys of nine female pigs were randomly divided into three groups. Those in Groups A and B underwent IPC-MPCNL through the new system composed of a pressure-measuring MPCNL suctioning sheath and an irrigation and suctioning platform with pressure feedback control. The infusion flow rate was 500 ml/min in Group A and 750 ml/min in Group B. Those in Group C underwent MPCNL at an infusion flow rate of 500 ml/min. The renal pelvic pressure (RPP) monitored by a ureteral catheter and that monitored by the pressure-measuring sheath in Groups A and B were compared. The RPP in Group C was monitored by a ureteral catheter. RESULTS The RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group A was - 5.59 ± 1.95 mmHg and 4.46 ± 2.08 mmHg, respectively. The RPP measured by the pressure-measuring sheath and that measured by the ureteral catheter in Group B was - 4.00 ± 2.01 mmHg and 5.92 ± 2.05 mmHg, respectively. Hence, the RPPs measured by the pressure-measuring sheath in Groups A and B were consistent with those measured by the ureteral catheter. The RPP in Group C was 27.75 ± 5.98 mmHg (large fluctuations). CONCLUSIONS IPC-MPCNL can be used to accurately monitor the RPP and maintain it within a preset safe range via suction. The new technique and the new system are safe and reliable.
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Affiliation(s)
- Zhongsheng Yang
- Department of Urology, The Affiliated Ganzhou Hospital, Jiangxi Medical College, Nanchang University, No. 16, Meiguan Road, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, China
- Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Donghu Street, Nanchang City, Jiangxi Province, 330006, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital, Jiangxi Medical College, Nanchang University, No. 16, Meiguan Road, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, China
| | - Yongming Huang
- Department of Urology, The Affiliated Ganzhou Hospital, Jiangxi Medical College, Nanchang University, No. 16, Meiguan Road, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, China
| | - Hua Chen
- Department of Urology, The Affiliated Ganzhou Hospital, Jiangxi Medical College, Nanchang University, No. 16, Meiguan Road, Zhanggong District, Ganzhou City, Jiangxi Province, 341000, China
| | - Ting Sun
- Department of Urology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwaizheng Street, Donghu Street, Nanchang City, Jiangxi Province, 330006, China.
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Yamashita S, Tanioku T, Deguchi R, Iwahashi Y, Higuchi M, Maruyama Y, Inoue T, Kikkawa K, Kohjimoto Y, Kawamata T, Hara I. In vitro comparison of simulated intrapelvic pressure in an artificial kidney model during retrograde intrarenal surgery among various single-use ureteroscopes. Int J Urol 2024; 31:177-181. [PMID: 37888949 DOI: 10.1111/iju.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES This study compares intrapelvic pressure (IPP) during retrograde intrarenal surgery with various single-use flexible ureteroscopes (f-URS) in an artificial kidney model. METHODS We created an artificial kidney model with a pressure sensor using a bladder evacuation device. The model was completely closed and the only backflow was on the side of the ureteroscope inside the ureteral access sheath (UAS). We tested five single-use f-URSs (LithoVue, Wiscope, PU3022A, PU3033A, and AXIS) with six different types of UAS (9.5/11.5-14/16 Fr). Using the automatic irrigation system, 30 s of irrigation was performed at various pressures (40-180 mmHg) and steady-state IPP was recorded. IPP was compared between the five single-use f-URSs. IPP cutoff value was determined at 30 mmHg. The diameter of the endoscope tip and the curved and shaft parts were also measured and recorded. RESULTS The diameters of all parts were significantly different between single-use f-URSs. The maximum IPP tended to be higher in ureteroscopes with larger diameters of the proximal parts (curved part/shaft part). In LithoVue and Uscope PU3022A f-URSs, the maximum IPP did not exceed 30 mmHg when UAS ≥12/14 Fr was used. In AXIS and Wiscope f-URSs, it did not exceed the cutoff value when the UAS ≥11/13 Fr was used. In Uscope PU3033A f-URS, it did not exceed 30 mmHg when the UAS ≥10/12 Fr was used. CONCLUSIONS Maximum IPP tended to be higher in f-URSs with larger diameters of the proximal part and the appropriate size of the UAS differed between various single-use f-URSs.
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Affiliation(s)
- Shimpei Yamashita
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Tadashi Tanioku
- Department of Anesthesiology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Ryusuke Deguchi
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yuya Iwahashi
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | | | - Yohei Maruyama
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Hyogo, Japan
| | - Kazuro Kikkawa
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Tomoyuki Kawamata
- Department of Anesthesiology, Wakayama Medical University Hospital, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University Hospital, Wakayama, Japan
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Hong A, Browne C, Jack G, Bolton D. Intrarenal pressures during flexible ureteroscopy: an insight into safer endourology. BJU Int 2024; 133 Suppl 3:18-24. [PMID: 37417458 DOI: 10.1111/bju.16113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
OBJECTIVES To assess intrarenal pressures (IRPs) and complication rates after flexible ureteroscopy (fURS), and to assess factors that contribute to raised IRPs and postoperative complications. PATIENTS AND METHODS After informed consent patients underwent fURS under general anaesthesia. The transducer of a 0.3556 mm (0.014″) pressure guidewire was placed in the renal pelvis for live recording of IRPs. The fURS procedures were performed in a routine manner under antibiotic cover with the aim of dusting the calculus to completion. The operating surgeon was blinded to the live-recorded IRPs. RESULTS A total of 40 fURS procedures were performed in 37 patients (26 male and 11 female). The mean age was 50.5 years. As a cohort, the mean of average IRPs was 34.8 mmHg and the mean of maximal IRPs was 128.8 mmHg. Pearson's correlation showed a significant inverse correlation between the mean IRP and age (r[38]: -0.391, P = 0.013). Three cases experienced postoperative deviations from uncomplicated recovery, with two being hypotensive and one case being both hypotensive and hypoxic. Three cases returned to the emergency department within 30 days of surgery, with two cases of flank pain and one case of urosepsis with positive urine cultures. The patient presenting with urosepsis had exhibited IRPs exceeding the mean. CONCLUSION The IRPs changed significantly from normal baseline levels during routine fURS. The mean IRP during fURS correlates with patient age, but not with other factors. The IRP may be related to increased complication rates at fURS. Understanding factors that influence IRP will allow urologists to better manage this intraoperatively.
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Affiliation(s)
- Anne Hong
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Cliodhna Browne
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Greg Jack
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
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Croghan SM, Cunnane EM, O'Meara S, Muheilan M, Cunnane CV, Patterson K, Skolarikos A, Somani B, Jack GS, Forde JC, O'Brien FJ, Walsh MT, Manecksha RP, McGuire BB, Davis NF. In vivo ureteroscopic intrarenal pressures and clinical outcomes: a multi-institutional analysis of 120 consecutive patients. BJU Int 2023; 132:531-540. [PMID: 37656050 DOI: 10.1111/bju.16169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To evaluate the pressure range generated in the human renal collecting system during ureteroscopy (URS), in a large patient sample, and to investigate a relationship between intrarenal pressure (IRP) and outcome. PATIENTS AND METHODS A prospective multi-institutional study was conducted, with ethics board approval; February 2022-March 2023. Recruitment was of 120 consecutive consenting adult patients undergoing semi-rigid URS and/or flexible ureterorenoscopy (FURS) for urolithiasis or diagnostic purposes. Retrograde, fluoroscopy-guided insertion of a 0.036-cm (0.014″) pressure guidewire (COMET™ II, Boston Scientific, Marlborough, MA, USA) to the renal pelvis was performed. Baseline and continuous ureteroscopic IRP was recorded, alongside relevant operative variables. A 30-day follow-up was completed. Descriptive statistics were applied to IRP traces, with mean (sd) and maximum values and variance reported. Relationships between IRP and technical variables, and IRP and clinical outcome were interrogated using the chi-square test and independent samples t-test. RESULTS A total of 430 pressure traces were analysed from 120 patient episodes. The mean (sd) baseline IRP was 16.45 (5.99) mmHg and the intraoperative IRP varied by technique. The mean (sd) IRP during semi-rigid URS with gravity irrigation was 34.93 (11.66) mmHg. FURS resulted in variable IRP values: from a mean (sd) of 26.78 (5.84) mmHg (gravity irrigation; 12/14-F ureteric access sheath [UAS]) to 87.27 (66.85) mmHg (200 mmHg pressurised-bag irrigation; 11/13-F UAS). The highest single pressure peak was 334.2 mmHg, during retrograde pyelography. Six patients (5%) developed postoperative urosepsis; these patients had significantly higher IRPs during FURS (mean [sd] 81.7 [49.52] mmHg) than controls (38.53 [22.6] mmHg; P < 0.001). CONCLUSIONS A dynamic IRP profile is observed during human in vivo URS, with IRP frequently exceeding expected thresholds. A relationship appears to exist between elevated IRP and postoperative urosepsis.
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Affiliation(s)
- Stefanie M Croghan
- Royal College of Surgeons Ireland (Strategic Academic Recruitment (StAR) Programme), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Eoghan M Cunnane
- School of Engineering, University of Limerick, Limerick, Ireland
- Bernal Institute, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sorcha O'Meara
- Royal College of Surgeons Ireland (Strategic Academic Recruitment (StAR) Programme), Dublin, Ireland
- Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Muheilan Muheilan
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Connor V Cunnane
- School of Engineering, University of Limerick, Limerick, Ireland
- Bernal Institute, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kenneth Patterson
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Andreas Skolarikos
- European Association of Urology (EAU) Urolithiasis Guidelines Panel, Arnhem, The Netherlands
- 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Bhaskar Somani
- European Association of Urology (EAU) Urolithiasis Guidelines Panel, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gregory S Jack
- Department of Urology, Austin Health, University of Melbourne, Parkville, Victoria, Australia
| | - James C Forde
- Department of Urology, Blackrock Clinic, Dublin, Ireland
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael T Walsh
- School of Engineering, University of Limerick, Limerick, Ireland
- Bernal Institute, University of Limerick, Limerick, Ireland
| | - Rustom P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Barry B McGuire
- Department of Urology, St. Michael's Hospital, Dublin, Ireland
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall F Davis
- Department of Urology, Blackrock Clinic, Dublin, Ireland
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland
- European Association of Urology (EAU) Urolithiasis Guidelines Panel, Arnhem, The Netherlands
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12
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Hong A, du Plessis J, Browne C, Jack G, Bolton D. Mechanism of urosepsis: relationship between intrarenal pressures and pyelovenous backflow. BJU Int 2023; 132:512-519. [PMID: 37309245 DOI: 10.1111/bju.16095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
To document the histological changes observed in renal units subjected to elevated intrarenal pressures (IRPs) and postulate the possible mechanisms of infectious complications after ureteroscopy. MATERIALS AND METHODS Ex vivo studies were performed on porcine renal models. Each ureter was cannulated with a 10-F dual-lumen ureteric catheter. A pressure-sensing wire was inserted through one lumen and with the sensor positioned in the renal pelvis for IRP measurement. Undiluted India ink stain was irrigated through the second lumen. Each renal unit was subjected to ink irrigation at target IRPs of 5 (control), 30, 60, 90, 120, 150, and 200 mmHg. Three renal units were subjected to each target IRP. After irrigation, each renal unit was processed by a uropathologist. Macroscopically, the amount of renal cortex stained by ink was calculated as a percentage of the total perimeter. Microscopically, presence of ink reflux into collecting ducts or distal convoluted tubules, and pressure-related features, was noted at each IRP. RESULTS Signs of pressure, as represented by collecting duct dilatation, was first observed at 60 mmHg. Ink staining was consistently observed in the distal convoluted tubules at IRPs ≥60 mmHg, and all renal units above this pressure showed renal cortex involvement. At ≥90 mmHg, ink staining was observed in venous structures. At 200 mmHg, ink staining was observed in supportive tissue, venous tributaries in the sinus fat, peritubular capillaries, and glomerular capillaries. CONCLUSION Using an ex vivo porcine model, pyelovenous backflow occurred at IRPs of ≥90 mmHg. Pyelotubular backflow occurred when irrigation IRPs were ≥60 mmHg. These findings have implications for the development of complications after flexible intrarenal surgery.
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Affiliation(s)
- Anne Hong
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Justin du Plessis
- Department of Anatomical Pathology, Austin Health Pathology, Austin Health, Heidelberg, Victoria, Australia
| | - Cliodhna Browne
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Gregory Jack
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
| | - Damien Bolton
- Department of Urology, Austin Health, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
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Setthawong T, Namwongsa T, Ketsuwan C. Retrograde vacuum-assisted MiniPCNL system for large distal ureteric calculus removal: A case report. Urol Case Rep 2023; 51:102622. [PMID: 38059075 PMCID: PMC10696236 DOI: 10.1016/j.eucr.2023.102622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 12/08/2023] Open
Abstract
Large ureteral calculi are commonly associated with severe colic pain, complex urinary tract infections, severe hematuria, hydronephrosis, and renal deterioration, often requiring immediate surgical intervention. Ureteroscopy is a favored treatment due to its higher stone-free rates; however, it encounters difficulties in cases of a high burden of distal ureteral stones. We present a case where a patient with a significant ureteral calculus was effectively treated with a vacuum-assisted mini-percutaneous nephrolithotomy system in retrograde approach. This intervention enabled the complete removal of the stone, leading to the patient's full recovery without complications.
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Affiliation(s)
- Tarapon Setthawong
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theerawech Namwongsa
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chinnakhet Ketsuwan
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sierra A, Corrales M, Kolvatzis M, Doizi S, Traxer O. Real Time Intrarenal Pressure Control during Flexible Ureterorrenscopy Using a Vascular PressureWire: Pilot Study. J Clin Med 2022; 12:jcm12010147. [PMID: 36614947 PMCID: PMC9821029 DOI: 10.3390/jcm12010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
(1) Introduction: To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during flexible ureterorenoscopy (f-URS) with a PressureWire and to optimize safety by assessing IPP during surgery. (2) Methods: Patients undergoing f-URS for different treatments were recruited. A PressureWire (0.014", St. Jude Medical, Little Canada, MN, USA) was placed into the renal cavities to measure IPP. Gravity irrigation at 40 cmH2O over the patient and a hand-assisted irrigation system were used. Pressures were monitored in real time and recorded for analysis. Fluid balance and postoperative urinary tract infection (UTI) were documented. (3) Results: Twenty patients undergoing f-URS were included with successful IPP monitoring. The median baseline IPP was 13.6 (6.8-47.6) cmH2O. After the placement of the UAS, the median IPP was 17 (8-44.6) cmH2O. With irrigation pressure set at 40 cmH2O without forced irrigation, the median IPP was 34 (19-81.6) cmH2O. Median IPP during laser lithotripsy, with and without the use of on-demand forced irrigation, was 61.2 (27.2-149.5) cmH2O. The maximum pressure peaks recorded during forced irrigation ranged from 54.4 to 236.6 cmH2O. After the surgery, 3 patients (15%) presented UTI; 2 of them had a positive preoperative urine culture, previously treated, and a positive fluid balance observed after the surgery. (4) Conclusion: Based on our experience, continuous monitoring of IPP with a wire is easy to reproduce, effective, and safe. In addition, it allows us to identify and avoid high IPPs, which may affect surgery-related complications.
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Affiliation(s)
- Alba Sierra
- Urology Department, Hospital ClÃnic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036 Barcelona, Spain
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020 Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France
| | - Mariela Corrales
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020 Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France
| | - Merkourios Kolvatzis
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020 Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France
- 2nd Department of Urology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Steeve Doizi
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020 Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France
| | - Olivier Traxer
- Sorbonne University GRC Urolithiasis No. 20 Tenon Hospital, F-75020 Paris, France
- Department of Urology AP-HP, Tenon Hospital, Sorbonne University, F-75020 Paris, France
- Correspondence:
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