Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure

Romeu, Juan Pablo Caballero; Galán-Llopis, J.-A.; Soria, Federico; Morcillo-Martín, E.; Caballero, Pablo; Garcia, Alejandro J.; Cruz-Conty, Julia E. De La; Romero‐Maroto, Jesús

doi:10.1007/s00345-018-2205-y

Cited by 12 publications

(3 citation statements)

References 27 publications

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“…The interplay between ureteroscope size, irrigation settings and IRP is presented in Table S2a. The impact of ureteroscope calibre was directly compared in one live animal study, with a finding of decreased IRP using a 4.85‐Fr vs an 8/9.8‐Fr ureteroscope (IRP ≥40 cmH 2 O in 10% vs 35%) [42]. In human studies, mean IRP of approximately 50 cmH 2 O occurs during URS with gravity‐controlled irrigation at 1 m height or 50 cmH 2 O pressure‐controlled irrigation [40,43]; however, higher pressures (mean 149.5 ± 6.2 cmH 2 O) have been recorded during in vivo porcine studies at similar irrigation settings [20].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…During endoscopic surgery, when IRP exceeds 40 cm H 2 O, arterial blood flow decreases, insufficient venous pressure occurs, and associated renal oxidative damage increases [32]. In studies on semirigid URS, IRP reported is 68-272 cm H 2 O [33][34][35]. In the literature, after URS and fURS, the AKI markers tend to increase within the first 4-6 h postoperatively and then decrease [22,36].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study

et al. 2021

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Introduction: Kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) are the leading novel biomarkers used efficiently in acute kidney injury (AKI). The levels of these biomarkers increase especially in the early period of nephrotoxic and ischemic renal damage. In this study, we aimed to investigate the clinical importance of NGAL and KIM-1 biomarkers used in the effective evaluation of kidney functions in patients with acute unilateral obstructive stone disease (AUOSD) in the management of endoscopic surgery. Materials and Methods: We prospectively included patients who underwent endoscopic surgery due to AUOSD between January 2018 and December 2019. Urine KIM-1 and NGAL values of the patients were measured preoperative period, postoperative 4th h, and postoperative 7th day. The patients were evaluated according to the location and size of the stone, the degree of renal hydronephrosis, the duration of the operation, complications, and JJ stent placement. Results: The study enrolled 50 patients. Urinary KIM-1/Cr and urinary NGAL/Cr ratios were higher in postoperative 4th h than in others (p < 0.001). Also, we found that urinary KIM-1/Cr and urinary NGAL/Cr ratios with Grade 2 and higher hydronephrosis were statistically higher than Grade 0–1 hydronephrosis (p < 0.001 and p: 0.042, respectively). Additionally, a preoperative urinary KIM-1 value of 1.24 ng/mL had a sensitivity of 78% and a specificity of 63% to predict the presence of hydronephrosis. When urine KIM-1 and NGAL results were compared with surgery time, stone size and location, serum creatinine (sCr) value, and Post-Ureteroscopic Lesion Scale grade, the difference was not statistically significant. Postoperative 7th day NGAL/Cr and KIM-1/Cr ratios were statistically higher in those with JJ stents placed (p: 0.03 and p: 0.004, respectively). Conclusion: KIM-1 and NGAL can be used in our assessment of renal function in patients with AUOSD, even if sCr is normal. Also, these biomarkers can predict the presence of hydronephrosis. It can be helpful in determining the time of surgical treatment, as well as providing information in the follow-up of patients with JJ stents after treatment.

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“…However, FIRS is known to lead to raised intrarenal pressures (IRPs) [7], with several studies suggesting that raised IRPs may contribute to higher infectious complications [8]. Various techniques have been suggested to reduce IRPs, such as use of ureteric access sheaths [9], smaller sized ureteroscopes [10], and manipulation of irrigation including isoproterenol irrigation [11]. Given that trends show infectious complications are also increasing over time [12,13], and sepsis being the most common cause of mortality following ureteroscopy for urolithiasis [14], it is pertinent that we understand the mechanism for infections during FIRS to better manage this.…”

Section: Introductionmentioning

confidence: 99%

Mechanism of urosepsis: relationship between intrarenal pressures and pyelovenous backflow

et al. 2023

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ObjectiveTo 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 MethodsEx 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.ResultsSigns 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.ConclusionUsing 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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Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure

Abstract: m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.

Cited by 12 publications

References 27 publications

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

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

Can Urinary KIM-1 and NGAL Predict Management Endoscopic Surgery in Acute Unilateral Obstructive Stone Disease? Results from a Prospective Cohort Study

Mechanism of urosepsis: relationship between intrarenal pressures and pyelovenous backflow

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