1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
2
|
Tsaturyan A, Keller EX, Peteinaris A, Gabriel FC, Pietropaolo A, Ballesta Martinez B, Tatanis V, Ventimiglia E, Esperto F, Sener TE, De Coninck V, Emiliani E, Hameed BMZ, Talso M, Mykoniatis I, Tzelves L, Kallidonis P. Fluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate? World J Urol 2024; 42:240. [PMID: 38630158 DOI: 10.1007/s00345-024-04926-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/06/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS). MATERIALS AND METHODS A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest. RESULTS 74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted. CONCLUSIONS Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.
Collapse
Affiliation(s)
- Arman Tsaturyan
- Department of Urology, Erebouni Medical Center, 0087, Yerevan, Armenia.
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands.
| | - Etienne X Keller
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, 8006, Zurich, Switzerland
| | | | - Faria-Costa Gabriel
- Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
- Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Amelia Pietropaolo
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | | | | | - Eugenio Ventimiglia
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Francesco Esperto
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Campus Biomedico University of Rome, 00128, Rome, Italy
| | - Tarik Emre Sener
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Marmara University School of Medicine, 34854, Istanbul, Turkey
| | - Vincent De Coninck
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, AZ Klina, 2930, Brasschaat, Belgium
| | - Esteban Emiliani
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08193, Barcelona, Spain
| | - B M Zeeshan Hameed
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Father Muller Medical College, Mangalore, Karnataka, 575002, India
| | - Michele Talso
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy
| | - Ioannis Mykoniatis
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Department of Urology, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece
| | - Lazaros Tzelves
- EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands
- Institute of Urology, University College Hospital London, London, NW1 2BU, UK
| | | |
Collapse
|
3
|
Wang L, Zhou Z, Gao P, Yang Y, Ding Q, Wu Z. Comparison of traditional and suctioning ureteral access sheath during retrograde intrarenal surgery in the treatment of renal calculi. Langenbecks Arch Surg 2024; 409:81. [PMID: 38430305 DOI: 10.1007/s00423-024-03275-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE This study aims to compare the efficiency and clinical outcomes between the suctioning ureteral access sheath (UAS) group and the traditional UAS group during retrograde intrarenal surgery (RIRS) for kidney stones and explore the impact of suctioning UAS on postoperative infectious complications. METHODS We retrospectively reviewed the clinical data of 162 patients with kidney stones who underwent RIRS with a traditional UAS (n = 74) or a suctioning UAS (n = 71) between March 2021 and May 2023. RESULTS The mean operative time in suctioning UAS group (39.03 ± 18.01 s) was significantly shorter than that (49.73 ± 20.77 s) in the traditional UAS group (P = 0.037). The mean postoperative hospital stay was significantly shorter in the suctioning UAS group (1.57 ± 0.82d) compared with the traditional UAS group (2.30 ± 1.6 2 d) (P = 0.032). The instant SFRs were significantly higher in the suctioning UAS group (88.73%) than in the traditional UAS group (75.68%) (P = 0.040). The overall SFR in suctioning UAS group (92.96%) was slightly higher than the traditional UAS group (85.14%). The incidence of overall complications was significantly higher in the traditional UAS group (35.14%) than in the suctioning UAS group (16.90%) (P = 0.013). In multivariate analysis, female patients (OR 0.053, P = 0.018), positive urine WBC (OR 10.382, P = 0.034), operative time > 60 min (OR 20.231, P = 0.032), and the application of traditional UAS (OR 0.042, P = 0.017) were independent risk factors associated with infectious complications. CONCLUSION We demonstrated that suctioning UAS provided a higher instant SFR and fewer postoperative infectious complications during RIRS, and patients with predictable risk factors for infectious complications could potentially benefit from the use of the suctioning UAS.
Collapse
Affiliation(s)
- Lujia Wang
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Zijian Zhou
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Peng Gao
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Yuanyuan Yang
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Qiang Ding
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China
| | - Zhong Wu
- Department of Urology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Rd, Shanghai, 200040, People's Republic of China.
- Clinical Research Center of Urolithiasis, Shanghai Medical College, Fudan University, Shanghai, 200040, People's Republic of China.
| |
Collapse
|
4
|
Bellouki O, Essakali A, Boualaoui I, Ibrahimi A, El Sayegh H, Nouini Y. Double-J placement complicated by endogenous endophthalmitis: A rare and serious outcome. Urol Case Rep 2023; 51:102608. [PMID: 38024511 PMCID: PMC10663666 DOI: 10.1016/j.eucr.2023.102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Endogenous endophthalmitis (EE) is a rare intraocular infection resulting from hematogenous microorganism spread, typically associated with underlying risk factors. We present a 52-year-old female with poorly-controlled diabetes and urolithiasis who developed EE following double-J stent placement for obstructive pyelonephritis. EE may occur due to increased intrarenal pressure during urological procedures. Timely recognition and intervention for rare complications like EE in urological patients are essential. This case highlights the importance of vigilance and collaboration between urologists and ophthalmologists in managing such cases.
Collapse
Affiliation(s)
- Omar Bellouki
- Urology “A” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Amine Essakali
- Ophthalmology “B” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Imad Boualaoui
- Urology “A” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Ahmed Ibrahimi
- Urology “A” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Hachem El Sayegh
- Urology “A” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Yassine Nouini
- Urology “A” Department, Ibn Sina University Hospital of Rabat, Morocco
- Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| |
Collapse
|
5
|
Han Z, Wang B, Liu X, Jing T, Yue W, Wang Y, Wang D. Intrarenal pressure study using 7.5 French flexible ureteroscope with or without ureteral access sheath in an ex-vivo porcine kidney model. World J Urol 2023; 41:3129-3134. [PMID: 37750958 DOI: 10.1007/s00345-023-04598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/23/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION 7.5F digital fURS and 9.5/11.5F ureteral access sheaths (UAS), both conventional (cUAS) and vacuum-assisted (vaUAS), are commercially available. Irrigation increases intrarenal pressure (IRP). This study analyzes the IRP with various irrigation rates using 7.5F fURS without UAS or with either cUAS or vaUAS in an ex-vivo porcine model. Pyelo-tubular backflow was also studied during these experiments. MATERIALS AND METHODS 11 porcine kidneys were used. 7.5F digital fURS was tested without UAS and with 9.5/11.5F cUAS and vaUAS. 6F pressure monitor catheters were placed into the upper and lower calyces. IRPs were recorded under different irrigation rates. When vaUAS was used, the air vent was either open or closed. 300 mmHg aspiration pressure was chosen. Lastly, contrasted irrigation fluid was delivered until IRP reached above 30 mmHg. Fluoroscopy images were obtained at 5 mmHg intervals over this threshold to study the pyelo-tubular backflow. RESULTS Using cUAS, IRP reached 30 mmHg with irrigation rates between 60 and 70 cc/min. Using vaUAS with vent closed, IRP never exceeded 10 mmHg with irrigation up to 120 cc/min. vaUAS with vent open performed marginally better than cUAS. fURS without UAS performed better than cUAS. Pyelo-tubular backflow became prominent at 40 mmHg. CONCLUSION In an ex-vivo porcine model, 7.5F fURS could be used safely without UAS with irrigation rates up to 120 cc/min. The safety margin dropped to 60-70 cc/min with cUAS. vaUAS with vent closed maintained IRP < 10 mmHg with irrigation rates up to 120 cc/min. Pyelo-tubular backflow was observed with IRP > 35 mmHg.
Collapse
Affiliation(s)
- Zhenyuan Han
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - Baosen Wang
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - Xiaohui Liu
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - Tao Jing
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - WenSu Yue
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - Yuliang Wang
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China
| | - Dong Wang
- Department of Urology, The People's Hospital of Huantai, Zibo, Shandong, China.
| |
Collapse
|
6
|
Marom R, Dau JJ, Ghani KR, Hall TL, Roberts WW. Change in renal blood flow in response to intrarenal pressure alterations induced by ureteroscopy in an in-vivo porcine model. World J Urol 2023; 41:3181-3185. [PMID: 37777598 DOI: 10.1007/s00345-023-04641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/06/2023] [Indexed: 10/02/2023] Open
Abstract
INTRODUCTION High irrigation rates are commonly used during ureteroscopy and can increase intrarenal pressure (IRP) substantially. Concerns have been raised that elevated IRP may diminish renal blood flow (RBF) and perfusion of the kidney. Our objective was to investigate the real-time changes in RBF while increasing IRP during Ureteroscopy (URS) in an in-vivo porcine model. METHODS Four renal units in two porcine subjects were used in this study, three experimental units and one control. For the experimental units, RBF was measured by placing an ultrasonic flow cuff around the renal artery, while performing ureteroscopy in the same kidney using a prototype ureteroscope with a pressure sensor at its tip. Irrigation was cycled between two rates to achieve targeted IRPs of 30 mmHg and 100 mmHg. A control data set was obtained by placing the ultrasonic flow cuff on the contralateral renal artery while performing ipsilateral URS. RESULTS At high IRP, RBF was reduced in all three experimental trials by 10-20% but not in the control trial. The percentage change in RBF due to alteration in IRP was internally consistent in each porcine renal unit and independent of slower systemic variation in RBF encountered in both the experimental and control units. CONCLUSION RBF decreased 10-20% when IRP was increased from 30 to 100 mmHg during ureteroscopy in an in-vivo porcine model. While this reduction in RBF is unlikely to have an appreciable effect on tissue oxygenation, it may impact heat-sink capacity in vulnerable regions of the kidney.
Collapse
Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA.
| | - Julie J Dau
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - William W Roberts
- Department of Urology, University of Michigan, 4432 Medical Science I, 1301 Catherine Street, Ann Arbor, MI, 48109-5330, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Marom R, Dau JJ, Hall TL, Ghani KR, Louters MM, Kim HJ, Khajeh NR, Roberts WW. Effect of outflow resistance on intrarenal pressure at different irrigation rates during ureteroscopy: in vivo evaluation. Urolithiasis 2023; 51:98. [PMID: 37515665 DOI: 10.1007/s00240-023-01470-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
To maintain visualization and control temperature elevation during ureteroscopy, higher irrigation rates are necessary, but this can increase intrarenal pressure (IRP) and lead to adverse effects like sepsis. The IRP is also dependent on outflow resistance but this has not been quantitatively evaluated in a biological system. In this study, we sought to characterize the IRP as a function of irrigation rate in an in vivo porcine model at different outflow resistances. Ureteroscopy was performed in a porcine model with a 9.5 Fr prototype ureteroscope containing a pressure sensor. A modified ureteral access sheath (UAS) (11/13 Fr, 36 cm) was configured to adjust outflow resistance. IRP-irrigation rate curves were generated at four different outlet resistances representing different outflow scenarios. At lower irrigation rates, the pressure change in response to increased irrigation was gradual and non-linear, likely reflecting a "compliant" phase of the renal collecting system. Once IRP reached the range of 35-50 cm H2O, the pressure increased in a linear fashion with irrigation rate, suggesting that the distensibility of the collecting system had become saturated. The relationship between IRP and irrigation rate becomes linear during in vivo porcine studies once the initial compliance of the system is saturated. IRP is more sensitive to changes in irrigation rate in systems with higher outflow resistance. The modified UAS is a novel research tool which allows variance of outflow resistance to mimic different clinical scenarios. Knowledge of outflow resistance may simplify the decision to use an UAS.
Collapse
Affiliation(s)
- Ron Marom
- Department of Urology, University of Michigan, MI, Ann Arbor, USA.
| | - Julie J Dau
- Department of Urology, University of Michigan, MI, Ann Arbor, USA
| | - Timothy L Hall
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Khurshid R Ghani
- Department of Urology, University of Michigan, MI, Ann Arbor, USA
| | | | - Hyung Joon Kim
- Department of Urology, Konyang University College of Medicine, Daejeon, South Korea
| | | | - William W Roberts
- Department of Urology, University of Michigan, MI, Ann Arbor, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
8
|
Guan W, Liang J, Wang D, Lin H, Xie S, Chen S, He J, Xu A. The effect of irrigation rate on intrarenal pressure in an ex vivo porcine kidney model-preliminary study with different flexible ureteroscopes and ureteral access sheaths. World J Urol 2023. [PMID: 36757468 DOI: 10.1007/s00345-023-04295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/04/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION Ureteral access sheath (UAS) and irrigation are used in flexible ureteroscopy (fURS). Both conventional UAS (cUAS) and vacuum-assisted UAS (vaUAS) are currently available. Irrigation increases the intrarenal pressure (IRP). Our objectives were to study the effects of various irrigation rates on IRP using different sizes of fURS in different sizes and functions of UAS. MATERIALS AND METHODS Ten freshly harvested porcine kidneys served as the study subjects. 11/13F and 12/14F cUAS and vaUAS with 2.8 mm and 3.2 mm fURS were experimented on in various scope/sheath combinations. 6F pressure monitor catheters were placed into upper, middle, and lower calyces. IRPs were recorded under different irrigation rates in cUAS and vaUAS, with either 150 or 300 mmHg aspiration pressures, and with air vent either open or closed. RESULTS 12/14F cUAS with 2.8 mm fURS could maintain IRPs below 35 mmHg with irrigation rates up to 200 cc/min. With 3.2 mm fURS, the rate dropped to 110-120 cc/min. With 12/14F vaUAS and vent closed, the IRP remained less than 5 mmHg at 200 cc/min irrigation for both fURS. For 11/13F cUAS, the < 35 mmHg threshold for 2.8 mm fURS was 80-90 cc/min; for 3.2 mm fURS, it was 30-40 cc/min. For 11/13F vaUAS with vent closed, IRPs remained < 5 mmHg at 200 cc/min irrigation for both scopes. CONCLUSION Both 12F cUAS and vaUAS can be used safely with 2.8 mm fURS up to 200 cc/min irrigation. With either a smaller sheath or a larger scope, vaUAS with vent closed can maintain IRP in a safe range up 200 cc/min irrigation. vaUAS with vent open performed marginally better than cUAS.
Collapse
|
9
|
Wang D, Han Z, Bi Y, Ma G, Xu G, Hu Q, Xi H. Comparison of intrarenal pressure between convention and vacuum-assisted ureteral access sheath using an ex vivo porcine kidney model. World J Urol 2022; 40:3055-3060. [PMID: 36208313 DOI: 10.1007/s00345-022-04149-23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/02/2022] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE This study aimed to prove the vacuum-assisted ureteral access sheath (vaUAS) is more effective in maintaining a lower IRP than conventional ureteral access sheath (cUAS). MATERIALS The model consisted of 12 freshly harvested adult porcine kidneys. METHODS Either a 12/14F cUAS or vaUAS was alternately inserted into the ureter to one cm below the renal pelvis. Upper, middle, and lower calyces were punctured, and 6F pressure monitor catheters were introduced. IRP with cUAS was monitored using various irrigation rates. IRP with vaUAS was monitored with the same irrigation rates; various aspiration pressures; and vent fully closed, 50% closed, and fully open. RESULTS cUAS with irrigation rate of 50 cc/min resulted in IRP < 30 mmHg. 50 to 100 cc/min should be used with caution. When irrigation rate exceeded 100 cc/min, IRP rose to ≥ 30 mmHg in most instances. With vent closed, vaUAS with vacuum pressure ≥ 150 mmHg and irrigation rate of 50 cc, 100 cc, and 150 cc/min generally resulted in IRPs < 5 mmHg. With vent half closed, vaUAS with vacuum pressure ≥ 300 mmHg and irrigation rate of ≤ 100 cc/min avoided IRP > 30 mmHg. vaUAS with vent open showed limited advantages over cUAS. CONCLUSION vaUAS maintains lower IRP than cUAS under same parameters. Both vaUAS and cUAS can be used when irrigation is ≤ 50 cc/min vaUAS showed clear advantages over cUAS in maintaining lower pressure when irrigation rate is ≥ 100 cc/min.
Collapse
Affiliation(s)
- Dong Wang
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Zhenyuan Han
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Yudong Bi
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Gang Ma
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Guibin Xu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Qianyi Hu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| |
Collapse
|
10
|
Wang D, Han Z, Bi Y, Ma G, Xu G, Hu Q, Xi H. Comparison of intrarenal pressure between convention and vacuum-assisted ureteral access sheath using an ex vivo porcine kidney model. World J Urol 2022; 40:3055-3060. [PMID: 36208313 DOI: 10.1007/s00345-022-04149-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/02/2022] [Indexed: 10/10/2022] Open
Abstract
OBJECTIVE This study aimed to prove the vacuum-assisted ureteral access sheath (vaUAS) is more effective in maintaining a lower IRP than conventional ureteral access sheath (cUAS). MATERIALS The model consisted of 12 freshly harvested adult porcine kidneys. METHODS Either a 12/14F cUAS or vaUAS was alternately inserted into the ureter to one cm below the renal pelvis. Upper, middle, and lower calyces were punctured, and 6F pressure monitor catheters were introduced. IRP with cUAS was monitored using various irrigation rates. IRP with vaUAS was monitored with the same irrigation rates; various aspiration pressures; and vent fully closed, 50% closed, and fully open. RESULTS cUAS with irrigation rate of 50 cc/min resulted in IRP < 30 mmHg. 50 to 100 cc/min should be used with caution. When irrigation rate exceeded 100 cc/min, IRP rose to ≥ 30 mmHg in most instances. With vent closed, vaUAS with vacuum pressure ≥ 150 mmHg and irrigation rate of 50 cc, 100 cc, and 150 cc/min generally resulted in IRPs < 5 mmHg. With vent half closed, vaUAS with vacuum pressure ≥ 300 mmHg and irrigation rate of ≤ 100 cc/min avoided IRP > 30 mmHg. vaUAS with vent open showed limited advantages over cUAS. CONCLUSION vaUAS maintains lower IRP than cUAS under same parameters. Both vaUAS and cUAS can be used when irrigation is ≤ 50 cc/min vaUAS showed clear advantages over cUAS in maintaining lower pressure when irrigation rate is ≥ 100 cc/min.
Collapse
Affiliation(s)
- Dong Wang
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Zhenyuan Han
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Yudong Bi
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Gang Ma
- Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China
| | - Guibin Xu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Qianyi Hu
- Department of Urology, The First Affiliated Hospital of Guangzhou Medical College, Guangzhou, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
| |
Collapse
|
11
|
Tsaturyan A, Lattarulo M, Adamou C, Pagonis K, Peteinaris A, Liourdi D, Vrettos T, Liatsikos E, Kallidonis P. The use of ureteral access sheath during mini-percutaneous nephrolithotomy with high-power holmium YAG laser. World J Urol 2022; 40:789-94. [PMID: 34853917 DOI: 10.1007/s00345-021-03894-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To present our preliminary results and describe a technical modification of mini-PCNL (12Fr) with the insertion of a ureteral access sheath (UAS) to facilitate the procedure. METHODS A prospective study for the time period of January 2020 to January 2021 was conducted including patients with renal stones sized ≤ 25 mm in whom prone mini-PCNL (tract size 12Fr) together with the retrograde insertion of UAS was performed. All patients had been prestented at least 1 week prior to the planned surgery. A single-step tract dilation to 12Fr diameter was performed through a nonpapillary medial puncture. The lithotripsy was achieved using high-power holmium yttrium aluminum garnet laser (Ho:YAG) with the 60 W power setting (40 Hz and 1.5 J). The follow-up investigations were planned at 1-month after the surgery. RESULTS In total, 32 patients with the median age and stone size of 56.5 (IQR = 53-62) years and 20.8 (IQR = 19.3-22.7) mm were included. The median operative and cumulative fluoroscopy time were 34.0 (IQR = 29.9-37.5) and 1.9 (1.8-2.1) min, respectively. The stone-free rate (SFR) at 1-month follow-up was 93.8% (30/32). Only one patient developed a fever and required prolonged antibiotic administration. None of the patients experienced clinically significant bleeding. CONCLUSION Our preliminary results showed that the use of UASs during mini-PCNL procedures is feasible and provides directed evacuation of the stone fragments reaching 93.8% SFR at a 1-month follow-up. Future well-designed studies are necessary to prove our findings.
Collapse
|
12
|
Doizi S, Uzan A, Keller EX, De Coninck V, Kamkoum H, Barghouthy Y, Ventimiglia E, Traxer O. Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model. World J Urol 2021; 39:2709-17. [PMID: 32955661 DOI: 10.1007/s00345-020-03450-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 09/07/2020] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model. METHODS A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH2O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr. RESULTS f-URS: IPP values ranged between 1.4 and 46.2 cmH2O. Factors reducing IPP were an irrigation pressure at 40 cmH2O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH2O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH2O. Factors reducing IPP were irrigation pressure at 40 cmH2O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH2O, while it decreased at 193 cmH2O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH2O. Occupancy of the working channel did not affect IPP at 40 cmH2O, while it increased at 193 cmH2O. CONCLUSION We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH2O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH2O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. RECENT FINDINGS Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions.
Collapse
Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece.
| |
Collapse
|
14
|
Zanetti SP, Lievore E, Fontana M, Turetti M, Gallioli A, Longo F, Albo G, De Lorenzis E, Montanari E. Vacuum-assisted mini-percutaneous nephrolithotomy: a new perspective in fragments clearance and intrarenal pressure control. World J Urol 2021; 39:1717-23. [PMID: 32591902 DOI: 10.1007/s00345-020-03318-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/16/2020] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To describe the vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) technique performed via the 16Ch ClearPetra sheath, to evaluate its outcomes and to analyze intrarenal pressure (IRP) fluctuations during surgery. METHODS Data from all consecutive vmPCNL procedures from September 2017 to October 2019 were prospectively collected. Data included patients' and stones characteristics, intra and peri-operative items, post-operative complications and stone clearance. Patients undergoing vmPCNL from March to October 2019 were submitted to IRP measurement during surgery. RESULTS A total of 122 vmPCNL procedures were performed. Median stone volume was 1.92 cm3. Median operative time was 90 min and median lithotripsy and lapaxy time was 28 min. Stone clearance rate was 71.3%. Thirty-one (25.2%) patients experienced post-operative complications, seven of which were Clavien 3. Postoperative fever occurred in nine (7.4%) patients and one (0.8%) needed a transfusion. No sepsis were observed. IRPs were measured in 22 procedures. Mean IRP was 15.3 cmH2O and median accumulative time with IRP > 40.78 cmH2O (pyelovenous backflow threshold) was 28.52 sec. Maximum IRP peaks were reached during the surgical steps when aspiration is closed (mainly pyelograms), whereas during lithotripsy and suction-mediated lapaxy, the threshold of 40.78 cmH2O was overcome in three procedures. CONCLUSIONS vmPCNL is a safe procedure with satisfactory stone clearance rates. Mean IRP was always lower than the threshold of pyelo-venous backflow and the accumulative time with IRP over this limit was short in most of the procedures. During lithotripsy and vacuum-mediated lapaxy, IRP rarely raised over the threshold.
Collapse
|
15
|
Doizi S, Letendre J, Cloutier J, Ploumidis A, Traxer O. Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study. World J Urol 2021; 39:555-61. [PMID: 32382840 DOI: 10.1007/s00345-020-03216-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/21/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during f-URS with a wire including a pressure sensor and to assess IPP profiles during the procedure. METHODS Patients undergoing f-URS for stone disease were recruited. A wire with pressure sensor was placed in the renal cavities to measure IPP. For these cases, either no ureteral access sheath (UAS) or 10/12 or 12/14-Fr UASs were used according to surgeon discretion. Irrigation was ensured by a combination of a continuous pressure generator set at 80 cmH2O and a hand-assisted irrigation system providing on-demand forced irrigation to provide proper visibility. Pressures were monitored in real time and recorded for analysis. RESULTS Four patients undergoing five f-URS were included. IPP monitoring was successful in all patients. Mean baseline IPP was 6 cmH2O. During f-URS with only the endoscope in the renal cavities and irrigation pressure set at 80 cmH2O without any forced irrigation, the mean IPP was 63 cmH2O. Mean IPP during laser lithotripsy with the use of on-demand forced irrigation was 115.3 cmH2O. The maximum pressure peaks recorded during this therapeutic period using forced irrigation ranged from 289.3 to 436.9 cmH2O. CONCLUSION High IPP levels may be achieved during f-URS with on-demand irrigation systems. The impact of these high pressures on the risk of complications and long-term consequences still need to be evaluated adequately. But, in this preliminary pilot study, IPP could be reliably and conveniently monitored and recorded using a wire with a digital pressure sensor.
Collapse
|
16
|
Strittmatter F, Bader MJ. [Role of pressure and temperature in ureterorenoscopy and percutaneous nephrolitholapaxy : Pressure and temperature changes during stone treatment]. Urologe A 2019; 58:1289-97. [PMID: 31501985 DOI: 10.1007/s00120-019-01034-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Ureterorenoscopy and percutaneous nephrolitholapaxy are minimally invasive procedures and are the standard procedures for the treatment of kidney stones and ureteral calculi. To achieve an adequate view, in both methods an optimal and sufficient irrigation flow is necessary. The intrarenal pressure is influenced by the irrigation pressure and irrigation volume and has to be controlled. Pathologically elevated intrarenal pressure can lead to irreversible damage of the kidneys. Lasers are frequently used for stone fragmentation. It has been shown in studies that the laser energy can lead to an increase in the temperature and that thermal effects can also damage the kidneys. This article provides the surgeon with an overview about the effects of temperature and pressure changes during ureterorenoscopy and percutaneous nephrolitholapaxy and how damages can be avoided.
Collapse
|
17
|
Tokas T, Skolarikos A, Herrmann TRW, Nagele U; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol 2019; 37:133-42. [PMID: 29915944 DOI: 10.1007/s00345-018-2379-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/12/2018] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To perform a review on the latest evidence related to intrarenal pressures (IRPs) generated during upper-tract endourology, and present different tools to maintain decreased values, to decrease complication rates. METHODS A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal-pelvic pressure. RESULTS IRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8-199.35, 3-40.8, 10-45 and 15.37-41.21 cm H2O, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30 cm H2O at an irrigation pressure (IP) of ≤ 100 cm H2O but could increase to > 40 cm H2O at an IP of 200 cm H2O. By utilizing the minimally invasive PCNL system, IRPs remain low at 20 cm H2O even at high IPs. Utilizing endoluminal isoproterenol during RIRS, could reduce IRP increases with a rate of 27-107%, and maintain low IRPs values, usually below 50 cm H2O. CONCLUSIONS Increased IRP values have been reported during RIRS and UASs constitute the most efficient tool for decreasing them. IRPs during mini-PCNL can be decreased utilizing the vacuum-cleaner and purging effects but might remain uncontrolled during micro- and ultra-mini PCNL. Intraluminal pharmacological treatment could play a role in IRP decrease, with isoproterenol being the most studied agent.
Collapse
|
18
|
Tokas T, Herrmann TRW, Skolarikos A, Nagele U. Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 2018; 37:125-131. [PMID: 29915945 DOI: 10.1007/s00345-018-2378-4] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To perform a review on the latest evidence related to normal and pathological intrarenal pressures (IRPs), complications of incremented values, and IRP ranges during endourology. METHODS A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal pelvic pressure. RESULTS Normal IRPs range from zero to a few cm H2O. Pyelovenous backflow may occur at pressure range of 13.6-27.2 cm H2O. During upper tract endourology, complications such as pyelorenal backflow, sepsis, and renal damage are directly related to increased IRPs. Duration of increased IRPs and concomitant obstruction are independent predictors of complication development. CONCLUSIONS IRP increase remains a neglected predictor of upper tract endourology complications and its intraoperative monitoring should be taken into consideration. Further research is necessary, to quantify pressures generated during upper tract endourology, and introduce means of controlling them.
Collapse
Affiliation(s)
- Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria.
| | - Thomas R W Herrmann
- Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland
| | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
| | - Udo Nagele
- Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria
| |
Collapse
|
19
|
Abstract
Currently, indications for flexible ureterorenoscopy (fURS) are expanding, mainly due to technological advancements. Although data from clinical series definitely presents fURS as a safe procedure, serious complications including sepsis and ureteral lesions do occur. These complications seem to be a result of the unique elements of fURS, ureteral access and irrigation, pushing normal upper urinary tract physiology into pathophysiological processes, including intrarenal/pyelo-veneous backflow and ureteral contractions, potentially resulting in septic, haemorrhagic and ureteral lesional complications. Knowledge on normal upper urinary tract physiology are crucial for understanding how these harmful effects of fURS may be avoided or minimized. The pathophysiology of intrarenal pressure increases and ureteral access will be discussed as a basis for understanding preventive measures. Role of antibiotics, ureteral access sheaths, safty guidewires, pain medication, prestenting and pharmacologic modulation of pyeloureteral dynamics are reviewed from a pathophysiological perspective.
Collapse
Affiliation(s)
- Palle J S Osther
- Urological Research Center, Department of Urology, Lillebaelt Hospital, Beridderbakken 4, 7100, Vejle, Denmark.
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Vejle, Denmark.
| |
Collapse
|