1
|
Yuming Z, Lei Y, Qiliang Z, Xin H, Jin K, Song L, Xiaolin D. Rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath for complex steinstrasse. BMC Urol 2024; 24:112. [PMID: 38807114 PMCID: PMC11131169 DOI: 10.1186/s12894-024-01501-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: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of rigid ureteroscopic lithotripsy with a pressure-controlling ureteral access sheath (PC-UAS) for complex steinstrasse. METHODS Thirty-one consecutive patients (male: 18; female: 13) with steinstrasse were enrolled, six of whom had concurrent kidney stones. The mean cumulative stone size was 2.7 ± 1.3 cm. The patients were treated with rigid ureteroscopic lithotripsy using a PC-UAS. The cavity pressure parameters were set as follows: control value at -15 mmHg to -2 mmHg, warning value at 20 mmHg, and limit value at 30 mmHg. The infusion flow rate was set at 150-200 ml/min. A holmium laser (550 μm) was used to powderize the stone at 2.0-2.5 J/pulse with a frequency of 20-30 pulses/s. Analyses included cavity pressure, operative time, stone-free rates, and complications. RESULTS Among the 31 patients, 29 were successfully treated with PC-UAS, with nine requiring adjunctive flexible ureteroscopy for stone migration to the kidney. Two procedures were converted to percutaneous nephrolithotomies due to failure of sheath placement. The cavity pressure of all 29 patients was well-maintained below 20 mmHg, with clear vision. The mean operative time was 48.2 ± 17.7 min. No complications, such as ureteral perforation, mucosal avulsion, or hemorrhage, occurred. Two cases of Clavien-Dindo grade I complications occurred. No major complications (Clavien-Dindo grade II-V) occurred. The mean postoperative hospitalization time was 1.7 days. The stone-free rates 1 day and 1 month after surgery were 93.1% and 96.6%, respectively. One patient with residual stones underwent extracorporeal shockwaves. CONCLUSIONS Rigid ureteroscopic lithotripsy with PC-UAS can effectively control the cavity pressure, shorten the operation time, and improve the efficiency of broken stones, thus reducing the complication rate.
Collapse
Affiliation(s)
- Zhong Yuming
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Yao Lei
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Zhai Qiliang
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Huang Xin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Kuang Jin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Leming Song
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China
| | - Deng Xiaolin
- Department of Urology, Ganzhou People's Hospital, 17 Hongqi Avenue, Ganzhou, 341000, Jiangxi, China.
| |
Collapse
|
2
|
Yuen SKK, Traxer O, Wroclawski ML, Gadzhiev N, Chai CA, Lim EJ, Giulioni C, De Stefano V, Nedbal C, Maggi M, Sarica K, Castellani D, Somani B, Gauhar V. Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath. Diagnostics (Basel) 2024; 14:1034. [PMID: 38786332 PMCID: PMC11120421 DOI: 10.3390/diagnostics14101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
The ureteral access sheath (UAS) has been a boon and a bane in flexible ureteroscopy (FURS), with its merits and demerits well established. Its design and dimensions were instrumental in reshaping the way flexible scopes were used and were key adjuncts to establishing retrograde intrarenal surgery (RIRS) as a standard of care in the endourological management of renal stones. With the ever-changing landscape of RIRS over the decades shaped by technological advancements in lasers and flexible scopes, the UAS has also continuously evolved. The utility of suction in endourology has recently changed the way RIRS is performed and is a game changer for FURS outcomes. With strong clinical and experimental evidence to support its use, the UAS has undergone a transformative change in the recent past, with its ability to monitor intrarenal pressure and provide a superior vacuum-cleaner effect that improves the trifecta of RIRS, namely an improved single-stage stone-free rate (SFR), minimise complications, and reduce reinterventions. Our comprehensive review outlines the key clinical and experimental evidence and traces the developments that were key to modifying the traditional UAS into a flexible and navigable suction ureteric access sheath (FANS) and highlights how the design and modifications, in turn, influence the ability to push the boundaries of RIRS.
Collapse
Affiliation(s)
- Steffi Kar Kei Yuen
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Olivier Traxer
- Department of Urology AP-HP, Sorbonne University, Tenon Hospital, 75020 Paris, France;
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, São Paulo 05652-900, Brazil;
- BP—A Beneficência Portuguesa de São Paulo, São Paulo 01451-010, Brazil
| | - Nariman Gadzhiev
- Urology Department, Saint-Petersburg State University Hospital, 197342 St. Petersburg, Russia;
| | - Chu Ann Chai
- Urology Unit, Surgery Department, University Malaya Medical Center, Petaling Jaya 50603, Malaysia;
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Carlo Giulioni
- Department of Urology, Casa di Cura Villa Igea, 60127 Ancona, Italy;
| | - Virgilio De Stefano
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Carlotta Nedbal
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
- Urology Unit, ASST Fatebenefratelli Sacco, 20131 Milano, Italy
| | - Martina Maggi
- Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Kemal Sarica
- Department of Urology, Biruni University, 34015 Istanbul, Turkey;
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero Universitaria delle Marche, 60121 Ancona, Italy; (V.D.S.); (C.N.); (D.C.)
| | - Bhaskar Somani
- Department of Urology, University Hospitals Southampton, NHS Trust, Southampton SO16 6YD, UK;
| | - Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore 126817, Singapore
| |
Collapse
|
3
|
Song B, Cheng Y, Lu Y, Rong H, Huang T, Shi J, Fang L. Factors affecting the intraoperative calculi excretion during flexible ureteroscopy lithotripsy: an in vitro analysis. World J Urol 2024; 42:130. [PMID: 38460016 DOI: 10.1007/s00345-024-04794-9] [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: 05/11/2023] [Accepted: 01/16/2024] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE To explore the parameters influencing intraoperative calculi excretion (ICE) during flexible ureteroscopy lithotripsy (fURL) using in vitro simulation experiments. METHODS 3D-printed human kidney models were used to simulate the elimination of gravel during fURL. The factors influencing the ICE during fURL were analyzed by comparing the effects of different degrees of hydronephrosis (mild, moderate, and severe), surgical positions (supine and lateral position), ratios of endoscope-sheath diameter (RESD) (0.625, 0.725, and 0.825), gravel sizes (0.50-1.00 mm, 0.25-0.50 mm, and 0.10-0.25 mm), and ureteral access sheaths (UASs) (traditional UAS and negative-pressure UAS) on ICE. RESULTS The impacts of various UAS, RESD, degree of hydronephrosis, surgical positions, and gravel sizes on ICE were all significant (p < 0.05). We found no evidence of multicollinearity for all the independent variables, and the linear regression equation fitted as ICE ( g / min ) = 0.102 + 0.083 ∗ UAS grade - 0.050 ∗ RESD grade - 0.048 ∗ hydronephrosis grade + 0.065 ∗ position grade - 0.027 ∗ gravel size grade (R2 = 0.569). CONCLUSION Employing negative-pressure UAS, smaller RESD, milder hydronephrosis, lateral position, and smaller gravel size contribute to improved ICE during fURL. Among them, the adoption of negative-pressure UAS had the most substantial effects.
Collapse
Affiliation(s)
- Baiyang Song
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People's Republic of China
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315211, People's Republic of China
| | - Yue Cheng
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People's Republic of China.
- Ningbo Clinical Research Center for Urological Disease, Ningbo, Zhejiang, 315010, People's Republic of China.
| | - Yunfei Lu
- Medical Record Statistics Room, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Hao Rong
- Health Science Center, Ningbo University, Ningbo, Zhejiang, 315211, People's Republic of China
| | - Ting Huang
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People's Republic of China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Jingyu Shi
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People's Republic of China
- Ningbo Clinical Research Center for Urological Disease, Ningbo, Zhejiang, 315010, People's Republic of China
| | - Li Fang
- Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, Zhejiang, 315010, People's Republic of China.
- Ningbo Clinical Research Center for Urological Disease, Ningbo, Zhejiang, 315010, People's Republic of China.
| |
Collapse
|
4
|
He X, Huang X, Zhai Q, Song L, Deng X. Retrograde intrarenal surgery with intelligent control of renal pelvic pressure for staghorn calculi: a case report. Front Med (Lausanne) 2024; 11:1321184. [PMID: 38327711 PMCID: PMC10847286 DOI: 10.3389/fmed.2024.1321184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024] Open
Abstract
Percutaneous nephrolithotomy is the gold standard treatment for staghorn calculi. However, this study reviews a case of an almost complete removal of staghorn calculi following one session of retrograde intrarenal surgery with intelligent control of renal pelvic pressure (RIRS-ICP). A 45 years-old female patient with an 8.3 × 4.5 cm complete staghorn stone was infected with Proteus mirabilis. Two sensitive antibiotics, piperacillin tazobactam and etimicin, were administered for 3 days. Semirigid 7/8.4 Fr ureteroscope was used to treat the renal pelvis and upper calyceal calculi for 57 min. A 550 μm holmium laser fiber with 2.0 J × 30 Hz was set. Next, a disposable flexible ureteroscope of 8.4 Fr was used to address residual middle and lower calyx stones for 94 min. A 200 μm holmium laser fiber with 1.0 J × 30 Hz was set. The renal pelvis pressure was controlled within 15 mmHg. A 2 mm CT scan on the first postoperative day showed inferior caliceal residue of approximately 1.0 × 0.6 cm. No complications occurred. This suggests that RIRS-ICP is a safe and effective treatment for staghorn calculi.
Collapse
Affiliation(s)
| | | | | | | | - Xiaolin Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, China
| |
Collapse
|
5
|
Pauchard F, Bhojani N, Chew B, Ventimiglia E. How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives. Actas Urol Esp 2024; 48:42-51. [PMID: 37832846 DOI: 10.1016/j.acuroe.2023.10.007] [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: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.
Collapse
Affiliation(s)
- F Pauchard
- Servicio de Urología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - N Bhojani
- División de Urología, Universidad de Montreal, Montreal, QC, Canada
| | - B Chew
- Departamento de Ciencias Urológicas, Universidad de British Columbia, Vancouver, BC, Canada
| | - E Ventimiglia
- División de Oncología Experimental/Unidad de Urología, Instituto de Investigación Urológica (URI), IRCCS Hospital San Raffaele, Milán, Italy.
| |
Collapse
|
6
|
Giulioni C, Castellani D, Traxer O, Gadzhiev N, Pirola GM, Tanidir Y, da Silva RD, Glover X, Giusti G, Proietti S, Mulawkar PM, De Stefano V, Cormio A, Teoh JYC, Galosi AB, Somani BK, Emiliani E, Gauhar V. Experimental and clinical applications and outcomes of using different forms of suction in retrograde intrarenal surgery. Results from a systematic review. Actas Urol Esp 2024; 48:57-70. [PMID: 37302691 DOI: 10.1016/j.acuroe.2023.06.001] [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: 01/25/2023] [Accepted: 02/24/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To identify the latest advances in suction devices and evaluate their effect in Retrograde intrarenal surgery (RIRS) and ureteroscopy for stones. BASIC PROCEDURES A systematic literature search was performed on 4th January 2023 using Scopus, PubMed, and EMBASE. Only English papers were included; both pediatric and adult studies were accepted. Duplicate studies, case reports, letters to the editor, and meeting abstracts were excluded. MAIN FINDINGS Twenty-one papers were selected. Several methods have been proposed for suction use in RIRS, such as through the ureteral access sheath or directly to the scope. Artificial intelligence can also regulate this system, monitoring pressure and perfusion flow values. All the proposed techniques showed satisfactory perioperative results for operative time, stone-free rate (SFR), and residual fragments. Moreover, the reduction of intrarenal pressure (induced by aspiration) was also associated with a lower infection rate. Even the studies that considered kidney stones with a diameter of 20 mm or higher reported higher SFR and reduced postoperative complications. However, the lack of well-defined settings for suction pressure and fluid flow prevents the standardization of the procedure. CONCLUSION Aspiration device in the surgical treatment of urinary stones favours a higher SFR, reducing infectious complications, as supported by the included studies. RIRS with a suction system provided to be a natural successor to the traditional technique, regulating intrarenal pressure and aspirating fine dust.
Collapse
Affiliation(s)
- C Giulioni
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy.
| | - D Castellani
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - O Traxer
- Servicio de Urología, Universidad de La Sorbona, Hospital Tenon (AP-HP), París, France
| | - N Gadzhiev
- Servicio de Endourología, Universidad Médica Estatal de San Petersburgo, Saint-Petersburgo, Russia
| | - G M Pirola
- Servicio de Urología, Hospital San Giuseppe, Grupo MultiMedica, Milán, Italy
| | - Y Tanidir
- Departamento de Urología, Facultad de Medicina, Universidad de Marmara, Estambul, Turkey
| | - R D da Silva
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - X Glover
- Departamento de Urología, Facultad de Medicina, Universidad de Colorado, United States
| | - G Giusti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - S Proietti
- Centro Europeo de Entrenamiento en Endourología, Hospital San Raffaele IRCCS, Milán, Italy
| | - P M Mulawkar
- Servicio de Urología, Hospital Superespecializado de Tirthankar, Akola, India; Universidad de Edimburgo, Edimburgo, United Kingdom
| | - V De Stefano
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - A Cormio
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - J Y-C Teoh
- Clínica de Urología S.H. Ho, Servicio de Cirugía, Facultad de Medicina, Universidad China de Hong Kong, Hong Kong, China
| | - A B Galosi
- Servicio de Urología, Azienda Ospedaliero-Universitaria delle Marche, Universidad Politécnica Marche, Ancona, Italy
| | - B K Somani
- Servicio de Urología, Hospital Universitario de Southampton, NHS Trust, Southampton, United Kingdom
| | - E Emiliani
- Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - V Gauhar
- Servicio de Urología, Hospital General Ng Teng Fong, Singapur, Singapore
| |
Collapse
|
7
|
Zhong Y, Xie D, Luo C, Liao X, Liu T, Deng X, Zhu L, Song L. Clinical application of flexible ureteroscopic sheath with controllable intraluminal pressure in treating ureteral stones. Asian J Urol 2023; 10:166-171. [PMID: 36942124 PMCID: PMC10023535 DOI: 10.1016/j.ajur.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/12/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of the study was to assess the clinical efficacy and safety of a combined perfusion suction platform with pressure feedback control function and an ureteroscopic suction sheath that can measure the ureteropelvic pressure in implementing lithotripsies. Methods Fifty-two patients who underwent lithotripsy under intelligent monitoring of ureteral intraluminal pressure from June 2016 to January 2018 were retrospectively recruited. The inclusion standard was stone diameter >1.5 cm but <2.5 cm. After the 12/14 Fr suction sheath was placed, manometer interface and suction interface of the sheath were connected to the platform via the pressure sensor and suction tube, respectively. The ureteroscope was connected to the platform perfusion pump, and the crushed stones were aspirated out under negative pressure. Results According to the location of the stone, 21 (40.4%) cases were classified as upper ureteral stones, 19 (36.5%) were midureteral stones, and 12 (23.1%) were lower ureteral stones. Forty-seven patients underwent successful primary sheath placement and lithotripsy with a mean operative time of 34.5 (standard deviation 18.3) min. Retrograde stone migration did not occur. There were eight patients with hematuria postoperatively. Serious complication was 1.9% with one case of ureteral perforation. Stone clearance was 95.7% at Day 1-2 postoperatively, and 100% at Day 30 postoperatively. Conclusion Ureteroscopic lithotripsy with intelligent pressure control using our device improved the efficiency of the lithotripsy and rate of stone clearance. The safety of the operation can be ensured. It is worth popularization and application in clinical practice.
Collapse
Affiliation(s)
- Yuming Zhong
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | | | - Chunxiang Luo
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Liaobu Township Community Health Service Center, Dongguan, Guangdong, China
| | - Xiaohui Liao
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Gan County District Dermatology Institute, Ganzhou, Jiangxi, China
| | - Tairong Liu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Xiaoling Deng
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Lunfeng Zhu
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Leming Song
- Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
- Corresponding author.
| |
Collapse
|
8
|
Croghan SM, Skolarikos A, Jack GS, Manecksha RP, Walsh MT, O'Brien FJ, Davis NF. Upper urinary tract pressures in endourology: a systematic review of range, variables and implications. BJU Int 2023; 131:267-279. [PMID: 35485243 DOI: 10.1111/bju.15764] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To systematically review the literature to ascertain the upper tract pressures generated during endourology, the relevant influencing variables and clinical implications. MATERIALS AND METHODS A systematic review of the MEDLINE, Scopus and Cochrane databases was performed by two authors independently (S.C., N.D.). Studies reporting ureteric or intrarenal pressures (IRP) during semi-rigid ureteroscopy (URS)/flexible ureterorenoscopy (fURS)/percutaneous nephrolithotomy (PCNL)/miniaturized PCNL (mPCNL) in the period 1950-2021 were identified. Both in vitro and in vivo studies were considered for inclusion. Findings were independently screened for eligibility based on content, with disagreements resolved by author consensus. Data were assessed for bias and compiled based on predefined variables. RESULTS Fifty-two studies met the inclusion criteria. Mean IRP appeared to frequently exceed a previously proposed threshold of 40 cmH2 O. Semi-rigid URS with low-pressure irrigation (gravity <1 m) resulted in a wide mean IRP range (lowest reported 6.9 cmH2 O, highest mean 149.5 ± 6.2 cmH2 O; animal models). The lowest mean observed with fURS without a ureteric access sheath (UAS) was 47.6 ± 4.1 cmH2 O, with the maximum peak IRP being 557.4 cmH2 O (in vivo human data). UAS placement significantly reduced IRP during fURS, but did not guarantee pressure control with hand-operated pump/syringe irrigation. Miniaturization of PCNL sheaths was associated with increased IRP; however, a wide mean human IRP range has been recorded with both mPCNL (lowest -6.8 ± 2.2 cmH2 O [suction sheath]; highest 41.2 ± 5.3 cmH2 O) and standard PCNL (lowest 6.5 cmH2 O; highest 41.2 cmH2 O). Use of continuous suction in mPCNL results in greater control of mean IRP, although short pressure peaks >40 cmH2 O are not entirely prevented. Definitive conclusions are limited by heterogeneity in study design and results. Postoperative pain and pyrexia may be correlated with increased IRP, however, few in vivo studies correlate clinical outcome with measured IRP. CONCLUSIONS Intrarenal pressure generated during upper tract endoscopy often exceeds 40 cmH2 O. IRP is multifactorial in origin, with contributory variables discussed. Larger prospective human in vivo studies are required to further our understanding of IRP thresholds and clinical sequelae.
Collapse
Affiliation(s)
- Stefanie M Croghan
- Royal College of Surgeons, Dublin, Ireland.,Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Andreas Skolarikos
- European Association of Urology Urolithiasis Guidelines, Arnhem, The Netherlands.,Department of Urology, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory S Jack
- Department of Urology, Austin Health, University of Melbourne, Parkville, VIC, Australia
| | - Rustom P Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland.,Department of Urology, St. James's Hospital, Dublin, Ireland.,Department of Surgery, Trinity College Dublin, Dublin, Ireland
| | - Michael T Walsh
- School of Engineering, Bernal Institute, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fergal J O'Brien
- Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall F Davis
- Royal College of Surgeons, Dublin, Ireland.,Department of Urology, Blackrock Clinic, Dublin, Ireland.,European Association of Urology Urolithiasis Guidelines, Arnhem, The Netherlands.,Department of Urology, Beaumont Hospital, Dublin, Ireland
| |
Collapse
|
9
|
Low-energy high-frequency Ho-YAG lithotripsy: is RIRS going forward? A case-control study. Urolithiasis 2021; 50:79-85. [PMID: 34424352 DOI: 10.1007/s00240-021-01282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
Retrograde Intra-Renal Surgery (RIRS) plays a primary role in renal stone treatment context. Energy, frequency and width of laser impulse can be modulated by surgeons to achieve better outcomes. In our study, patients with single renal stone sized 10-20 mm were retrospectively divided into two groups. Patients of Group 1 underwent RIRS with Low-Energy (LE) High-Frequency (HF) settings using Lumenis® 120-W high-power Ho:YAG laser. Patients of Group 2 (control) underwent RIRS using "standard" settings by means of Sphinx® Jr 30 W Ho:YAG system. Follow-up was conducted with a CT scan at 3 months after RIRS in both groups. Procedure success was defined as stone-free or presence of ≤ 4 mm fragments (Clinical Insignificant Residual Fragments-CIRF). A total number of 199 patients were included: 86 LE/HF RIRS (Group 1) vs 113 "conventional" RIRS (Group 2). Mean operative time was 56.6 (± 19.4) min in Group 1 vs 65.2 (± 25.2) min in Group 2 (p = 0.01). Mean hospitalization time was 2.5 ± 1.7 days for Group 1 vs 2.9 ± 3.2 days for Group 2 (p = 0.2). Peri-operative complications were counted: eight in Group 1 and 11 in Group 2 (p > 0.05). At 3-month control, stone-free rate was 69% (59/86 patients) in Group 1 vs 65% (73/113 patients) in Group 2 (p = 0.6). Success rate was 93% (80/86) in Group 1 in comparison to 82% (93/113) in Group 2 (p = 0.03). In conclusion, LE/HF RIRS seems to be a feasible and effective technique with a reduction of operative time and optimal results in terms of "stone-free" and "success" rates. Further studies are needed to ensure the validity of our results and to give evidence-based statements.
Collapse
|
10
|
Çakici MÇ, Özok HU, Erol D, Çatalca S, Sari S, Özdemir H, Selmi V, Kartal İG, Karakoyunlu N. Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. MINERVA UROL NEFROL 2019; 71:636-643. [DOI: 10.23736/s0393-2249.19.03481-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
11
|
Li JK, Teoh JY, Ng CF. Updates in endourological management of urolithiasis. Int J Urol 2018; 26:172-183. [PMID: 30575154 DOI: 10.1111/iju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022]
Abstract
Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.
Collapse
Affiliation(s)
- Joseph Km Li
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Yc Teoh
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi-Fai Ng
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|