Fluid Absorption during Ureterorenoscopy

Upper urinary tract pressures in endourology: a systematic review of range, variables and implications

“…It is possible that higher IRP may be recorded during a real-life treatment time frame, particularly in an in vivo setting, should the bladder be allowed to fill. It is known in practice that irrigation fluid during fURS continues to be absorbed at a rate of approximately 1 mL/min throughout the procedure, suggesting that IRP is at least maintained [81]. Whilst it has been recommended to limit URS operative times to 90 min, as procedure duration may be an independent risk factor for the occurrence of complications [82], IRP may conceivably increase or display nonlinear dynamics over the procedure timeframe.…”

Comparison of Peditrol® Irrigation Device and Common Methods of Irrigation

“…Previous studies by our group have demonstrated minimal fluid absorption, in the region of 1 mL/min, during ureteroscopy at irrigation pressures of 300 cm H 2 O. 2 The mean intrarenal pressures seen with the flexible ureteroscope in the renal pelvis with no sheath in place was 92 cm H 2 O with the Peditrol, 97 cm H 2 O with a 60-cc syringe, and 58 cm H 2 O with pressure bag irrigation at 300 cm H 2 O (P Ͼ 0.05). This is above the threshold of 30 cm H 2 O commonly quoted as a target maximum but equivalent to or less than the pressure where pig kidneys show acute and chronic damage in the form of renal scarring, 1,10 Others have found similar pressures in human kidneys during ureteroscopy, and two trials measuring intrapelvic pressure with and without ureteral access sheaths have demonstrated pressures remarkably similar to those in this study.…”

“…1 However, even irrigation pressures in excess of this threshold have been shown to result in only limited absorption of irrigation fluid. 2 The Peditrol ® is a foot-activated syringe-based irrigation system. A 3-mL syringe is secured within the foot pedal, with two one-way valves incorporated into the tubing, one between the syringe and the irrigation bag and the other between the syringe and the endoscope (Fig.…”

Addition of Sodium Bicarbonate to Irrigation Solution May Assist in Dissolution of Uric Acid Fragments During Ureteroscopy

“…In 2004, Cybulski et al published a study suggesting that routine URS is associated with minimal systemic fluid absorption, even if ureteral perforation occurs. [15] Therefore, complications secondary to hypernatremia should be extremely low. However, the risk is not zero and patient safety is of chief importance.…”