Retrograde intra renal surgery and safety: pressure and temperature. A systematic review

Panthier, F.; Pauchard, Felipe; Traxer, Olivier

doi:10.1097/mou.0000000000001102

Cited by 13 publications

(5 citation statements)

References 60 publications

(108 reference statements)

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“…This is why, to some extent, this is also considered as the temperature threshold for human tissue at 43°C. During extracorporeal shock wave lithotripsy, the irrigation rate plays a very important factor in determining the temperature of the tissue [7]. The use of high irrigation rates will help avoid increased temperatures inside the kidney.…”

Section: Discussionmentioning

confidence: 99%

Experimental study of irrigation rate, ODC and intrarenal temperature in superpulse fiber thulium laser lithotripsy

ding,

2024

Preprint

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The present study aimed to examine the relationship of irrigation velocity, operator duty cycle (ODC), and intrarenal temperature during extracorporeal shockwave lithotripsy with a superpulse fiber thulium laser. Calcium oxalate monohydrate stones were implanted in the renal pelvis of fresh pig kidneys. Puncture technology was used to place a temperature probe accurately in the renal parenchyma about 2 mm away from the stone. To simulate the temperature at which a human body is exposed, that is, 37°C, the experiment was executed in an equilibrated laboratory at a constant temperature of 25°C with 60% humidity. The power of the laser varied between 10W and 30W; that of the irrigation varied from 10 to 30 ml/min. The time that the laser was applied was set at 120 s. Changes in the temperature were recorded online. A direct proportionality of temperature in the kidney to the rate of irrigation has been reported between 10 W and 30 W laser powers. The percentage ratio of the rate of irrigation and power in the laser is 1:1, which can keep the temperature in the kidney at a safe level. More specifically, at a laser power of 20 W and irrigation of 10 ml/min, the temperature inside the kidney increases sharply with the increase in ODC. By decreasing the ratio of ODC, the increase of temperature inside the kidney can be brought to a great reduction. The ratio of laser power to that of irrigation speed should be 1:1; hence, damage or injury to kidney tissue can be efficiently prevented from thermal changes.

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Section: Discussionmentioning

confidence: 99%

Experimental study of irrigation rate, ODC and intrarenal temperature in superpulse fiber thulium laser lithotripsy

ding,

2024

Preprint

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“…With the evolution of suction application in retrograde intrarenal surgery and the advancing technologies that allow for IRP measurement and a better physiological understanding of the detrimental effects of high IRP, the use of SUAS and FANS in RIRS has gained momentum to prevent the complications related to high IRP and temperature [27,[93][94][95][96].…”

Section: The Influence Of Pressure With the Use Of Suas And Fans In Rirsmentioning

confidence: 99%

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Yuen,

Traxer,

Wroclawski

et al. 2024

Diagnostics

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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.

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“…Temperature can reach 60°C after 10 s of laser activation at 40W 34 , 35 . Hence, consistent monitoring is crucial for preventing surgical and infectious complications 36 . When the IRP exceeds 30 mmHg and persists for over 45 s, the postoperative infection rate increases 3.277 fold compared to an IRP of ≤30 mmHg, and development of systemic inflammatory response syndrome becomes more likely.…”

Section: Application Of Ureteroscopy In Renal Calculimentioning

confidence: 99%

Recent advances in the treatment of renal stones using flexible ureteroscopys

He,

Dong,

Cai

et al. 2024

International Journal of Surgery

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Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL). The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers (TFL) and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing flexible ureteroscopy for the treatment of renal calculi in order to generate insights for further research.

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Retrograde intra renal surgery and safety: pressure and temperature. A systematic review

Cited by 13 publications

References 60 publications

Experimental study of irrigation rate, ODC and intrarenal temperature in superpulse fiber thulium laser lithotripsy

Experimental study of irrigation rate, ODC and intrarenal temperature in superpulse fiber thulium laser lithotripsy

Scoping Review of Experimental and Clinical Evidence and Its Influence on Development of the Suction Ureteral Access Sheath

Recent advances in the treatment of renal stones using flexible ureteroscopys

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