Novel syphon ureteric access sheath has the potential to improve renal pressures and irrigant flow

et al. 2023

Preprint

Objective To propose the suitable diameter of calculus debris produced during flexible ureteroscopy lithotripsy (fURL). Methods A glass tube was used to simulate the stone excretion process during Furl. Different stone diameters (0.50–1.00 mm, 0.25–0.50 mm, and 0.10–0.25 mm) with three sizes of flexible ureteroscopy (fURS) (Fr7.5, Fr8.7, and Fr9.9) and ureteral access sheath (UAS) (12/14Fr) with or without negative pressure suction were employed in the experiment. The intraoperative calculi excretion (ICE) was recorded according to the stones discharged from the gap between Furs and UAS. Results The ICE raised significantly in thinner fURS and UAS due to the smaller ratio of endoscope-sheath diameter (RESD). The gravel size ≤ 0.25 mm was conducive to drainage with traditional UAS, while using fURS with negative-pressure UAS could significantly improve ICE. The gravel size ≤ 0.5 mm was conducive to expulsion. Conclusion We clarify that ICE during ureteroscopy relates to RESD and negative pressure suction. The proper size of the stone fragment is critical in ensuring the expulsion during fURL, ≤ 0.25 mm in traditional UAS and ≤ 0.50 mm in negative-pressure UAS, respectively.

Section: Discussionmentioning

confidence: 99%

What is the appropriate gravel size during ureteroscopy lithotripsy? An in vitro evaluation

Song

Jin

et al. 2023

Preprint

“…NP-UAS can prevent excessive intraoperative IRP and lower the risk of postoperative infection and fever by converting passive water circulation to active under negative pressure [12,[18][19][20][21]. Simultaneously, active stone suction aid in the release of gravels from the gap between fURS and UAS, decreasing the "snow storm" phenomena during dusting lithotripsy and preserving intraoperative visibility [13].…”

Section: Discussionmentioning

confidence: 99%

What is the appropriate gravel size during ureteroscopy lithotripsy? An in vitro evaluation

Song

Jin²,

et al. 2023

Urolithiasis

To propose the suitable diameter of calculus debris produced during flexible ureteroscopy lithotripsy (fURL). A glass tube was used to simulate the stone excretion process during Furl. Different stone diameters (0.50–1.00 mm, 0.25–0.50 mm, and 0.10–0.25 mm) with three sizes of flexible ureteroscopy (fURS) (7.5Fr, 8.7Fr, and 9.9Fr) and ureteral access sheath (UAS) (12/14Fr) with or without negative pressure suction were employed in the experiment. The intraoperative calculi excretion (ICE) was recorded according to the stones discharged from the gap between fURS and UAS. The ICE raised significantly in thinner fURS and UAS due to the smaller Ratio of Endoscope-Sheath Diameter (RESD). The gravel size ≤ 0.25 mm was conducive to drainage with traditional UAS, while using fURS with negative-pressure UAS could significantly improve ICE. The gravel size ≤ 0.5 mm was conducive to expulsion. We clarify that ICE during ureteroscopy relates to RESD and negative pressure suction. The proper size of the stone fragment is critical in ensuring the expulsion during fURL, ≤ 0.25 mm in traditional UAS and ≤ 0.50 mm in negative-pressure UAS, respectively.

“…With advances in technology, a variety of UAS have been invented and used in clinical applications [12,14,15]. Some consensus may be outdated or changed.…”

Section: Discussionmentioning

confidence: 99%

“…A localized higher IRP is generated at the tip of the f-URS when the tip of the f-URS and the tip of the UAS are at the same level, which we think is generated because of the shock of the irrigation uid, because there was no signi cant difference in IRP between the two groups elsewhere. The IRP can be reduced by connecting a vacuum device [13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Optimal placement of ureteral access sheath in retrograde intrarenal surgery

Chen

Yang

et al. 2023

Preprint

Purpose: To explore the optimal location of ureteral access sheath (UAS) in retrograde intrarenal lithotripsy (RIRS). Materials and methods: RIRS model was built by AutoCAD 2011 software, and imported COMSOL 5.6 software to computer simulation. An RIRS model was constructed in vitro to analyze the distribution pattern of stone fragments, and compare the weight of stone fragments carried out by the irrigation fluid when the UAS is in different positions. Results: Computer simulation showed that the highest flow of irrigation fluid was in the channel of flexible ureteroscopy (f-URS) and in the lumen of UAS. From the f-URS to the renal collection system and then to the UAS, the velocity of irrigation fluid changes gradually from high-flow to low-flow and then to high-flow. When the f-URS and the UAS are at the same level, the irrigation fluid is always at a state of high flow during the process from f-URS to UAS. When the f-URS and the UAS are at the same level, it can increase the local intrarenal pressure (IRP) at the front of f-URS. The stone fragments are mainly sediment in the low-flow region of irrigation fluid. More stone fragments could follow the irrigation fluid out of the body when the tip of f-URS and the tip of UAS are at the same level (P＜0.001). Conclusions: The UAS should be brought closer to the stone in RIRS. And more stone fragments can be taken out of the body by the effect of irrigation fluid.