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

Croghan, Stefanie; Skolarikos, Andreas; Jack, Gregory S.; Manecksha, Rustom P.; Walsh, Michael T.; O’Brien, Fergal J.; Davis, Niall F.

doi:10.1111/bju.15764

Cited by 23 publications

(16 citation statements)

References 88 publications

(206 reference statements)

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“…While the present study did not find statistically significant correlations between IRPs and gender, type of ureteroscope used, use of a UAS, size of the UAS, type of irrigation used, BMI or duration of surgery, several of these factors have previously been documented to affect IRPs under specific circumstances [7]. Patel et al [21] examined IRPs without and with UAS, and the mean IRPs were 41.3 and 17.9 mmHg, respectively.…”

Section: Discussioncontrasting

confidence: 66%

“…Several models have demonstrated that higher irrigation pressures and the use of manual irrigation increases IRPs [7]; however, limited data are available in human studies. Wilson et al [24] used fURS with a 3.6-F working port and gravity irrigation, 100 and 200 mmHg pressure irrigation, gentle manual pump irrigation, and forceful manual pump irrigation and found that that IRPs reached 36, 70, 198, 85 and 345 mmHg, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly consideration should be given to the intraoperative features of fURS that could contribute to complications. Intrarenal pressures (IRPs) are documented to rise during fURS [5], and it is hypothesised that pyelovenous backflow from these raised IRPs [6] contributes to complications [7].…”

Section: Introductionmentioning

confidence: 99%

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Intrarenal pressures during flexible ureteroscopy: an insight into safer endourology

et al. 2023

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ObjectivesTo assess intrarenal pressures (IRPs) and complication rates after flexible ureteroscopy (fURS), and to assess factors that contribute to raised IRPs and postoperative complications.Patients and MethodsAfter informed consent patients underwent fURS under general anaesthesia. The transducer of a 0.3556 mm (0.014″) pressure guidewire was placed in the renal pelvis for live recording of IRPs. The fURS procedures were performed in a routine manner under antibiotic cover with the aim of dusting the calculus to completion. The operating surgeon was blinded to the live‐recorded IRPs.ResultsA total of 40 fURS procedures were performed in 37 patients (26 male and 11 female). The mean age was 50.5 years. As a cohort, the mean of average IRPs was 34.8 mmHg and the mean of maximal IRPs was 128.8 mmHg. Pearson's correlation showed a significant inverse correlation between the mean IRP and age (r[38]: −0.391, P = 0.013). Three cases experienced postoperative deviations from uncomplicated recovery, with two being hypotensive and one case being both hypotensive and hypoxic. Three cases returned to the emergency department within 30 days of surgery, with two cases of flank pain and one case of urosepsis with positive urine cultures. The patient presenting with urosepsis had exhibited IRPs exceeding the mean.ConclusionThe IRPs changed significantly from normal baseline levels during routine fURS. The mean IRP during fURS correlates with patient age, but not with other factors. The IRP may be related to increased complication rates at fURS. Understanding factors that influence IRP will allow urologists to better manage this intraoperatively.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Intrarenal pressures during flexible ureteroscopy: an insight into safer endourology

et al. 2023

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“…4 Elevation of intrapelvic pressure (IPP) can lead to pyelorenal backflow, including pyelovenous, pyelolymphatic, pyelotubular, and pyelointerstitial backflow, and increase the risk of postoperative infection. 5 Prevention of elevated IPP is therefore important to decrease the risk of postoperative infection after RIRS. The size of f-URS, the size of ureteral access sheath (UAS), and the compatibility between them are associated with IPP and should be considered as a means of preventing the elevation of IPP.…”

Section: Introductionmentioning

confidence: 99%

“…Elevation of intrapelvic pressure (IPP) can lead to pyelorenal backflow, including pyelovenous, pyelolymphatic, pyelotubular, and pyelointerstitial backflow, and increase the risk of postoperative infection 5 . Prevention of elevated IPP is therefore important to decrease the risk of postoperative infection after RIRS.…”

Section: Introductionmentioning

confidence: 99%

In vitro comparison of simulated intrapelvic pressure in an artificial kidney model during retrograde intrarenal surgery among various single‐use ureteroscopes

Yamashita,

Tanioku,

Deguchi

et al. 2023

Int J of Urology

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ObjectivesThis study compares intrapelvic pressure (IPP) during retrograde intrarenal surgery with various single‐use flexible ureteroscopes (f‐URS) in an artificial kidney model.MethodsWe created an artificial kidney model with a pressure sensor using a bladder evacuation device. The model was completely closed and the only backflow was on the side of the ureteroscope inside the ureteral access sheath (UAS). We tested five single‐use f‐URSs (LithoVue, Wiscope, PU3022A, PU3033A, and AXIS) with six different types of UAS (9.5/11.5–14/16 Fr). Using the automatic irrigation system, 30 s of irrigation was performed at various pressures (40–180 mmHg) and steady‐state IPP was recorded. IPP was compared between the five single‐use f‐URSs. IPP cutoff value was determined at 30 mmHg. The diameter of the endoscope tip and the curved and shaft parts were also measured and recorded.ResultsThe diameters of all parts were significantly different between single‐use f‐URSs. The maximum IPP tended to be higher in ureteroscopes with larger diameters of the proximal parts (curved part/shaft part). In LithoVue and Uscope PU3022A f‐URSs, the maximum IPP did not exceed 30 mmHg when UAS ≥12/14 Fr was used. In AXIS and Wiscope f‐URSs, it did not exceed the cutoff value when the UAS ≥11/13 Fr was used. In Uscope PU3033A f‐URS, it did not exceed 30 mmHg when the UAS ≥10/12 Fr was used.ConclusionsMaximum IPP tended to be higher in f‐URSs with larger diameters of the proximal part and the appropriate size of the UAS differed between various single‐use f‐URSs.

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Mini Percutaneous Nephrolithotomy

Angerri,

Boeykens,

Tailly

2023

Percutaneous Renal Surgery

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

Abstract: Upper urinary tract pressures in endourology: a systematic review of range, Upper urinary tract pressures in endourology: a systematic review of range, variables and implications variables and implications AUTHOR(S)

Cited by 23 publications

References 88 publications

Intrarenal pressures during flexible ureteroscopy: an insight into safer endourology

Intrarenal pressures during flexible ureteroscopy: an insight into safer endourology

In vitro comparison of simulated intrapelvic pressure in an artificial kidney model during retrograde intrarenal surgery among various single‐use ureteroscopes

Mini Percutaneous Nephrolithotomy

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