nach oben

Erschienen in:

21.09.2020 | Original Article

Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model

verfasst von: Steeve Doizi, Audrey Uzan, Etienne Xavier Keller, Vincent De Coninck, Hatem Kamkoum, Yazeed Barghouthy, Eugenio Ventimiglia, Olivier Traxer

Erschienen in: World Journal of Urology | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model.

Methods

A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH₂O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr.

Results

f-URS: IPP values ranged between 1.4 and 46.2 cmH₂O. Factors reducing IPP were an irrigation pressure at 40 cmH₂O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH₂O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH₂O. Factors reducing IPP were irrigation pressure at 40 cmH₂O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH₂O, while it decreased at 193 cmH₂O.

Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH₂O. Occupancy of the working channel did not affect IPP at 40 cmH₂O, while it increased at 193 cmH₂O.

Conclusion

We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH₂O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH₂O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.

Nur mit Berechtigung zugänglich

Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline. PART I J Urol 196(4):1153–1160CrossRef

Türk C, Skolarikos A, Neisius A, Petřík A, Seitz C, Knoll T. EAU Guidelines on urolithiasis. https://uroweb.org/guideline/urolithiasis, 2019

Denstedt J, de la Rosette J. Stone disease. https://www.siu-urology.org/society/siu-icud, 2014

Pradère B, Doizi S, Proietti S, Brachlow J, Traxer O (2018) Evaluation of guidelines for surgical management of urolithiasis. J Urol 199(5):1267–1271CrossRef

Hinman F, Redewill FH (1926) Pyelovenous back flow. JAMA 87(16):1287–1293CrossRef

Boccafoschi C, Lugnani F (1985) Intra-renal reflux. Urol Res 13(5):253–258CrossRef

Zhong W, Leto G, Wang L, Zeng G (2015) Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: a study of risk factors. J Endourol 29(1):25–28CrossRef

Tokas T, Herrmann TRW, Skolarikos A, Nagele U, Training, and Research in Urological Surgery, and Technology (T.R.U.S.T.) Group (2019) Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol. 37(1):125–131CrossRef

10.

Kiil F (1953) Pressure recordings in the upper urinary tract. Scand J Clin Lab Invest 5(4):383–384CrossRef

11.

Mulvaney WP (1963) The hydrodynamics of renal irrigations: with reference to calculus solvents. J Urol 89:765–768CrossRef

12.

Stenberg A, Bohman SO, Morsing P, Müller-Suur C, Olsen L, Persson AE (1988) Back-leak of pelvic urine to the bloodstream. Acta Physiol Scand 134(2):223–234CrossRef

13.

Schwalb DM, Eshghi M, Davidian M, Franco I (1993) Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study. J Urol 149(6):1576–1585CrossRef

14.

Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, Srinivas R, Sundaram CP, Clayman RV (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61(4):713–718CrossRef

15.

Ng YH, Somani BK, Dennison A, Kata SG, Nabi G, Brown S (2010) Irrigant flow and intrarenal pressure during flexible ureteroscopy: the effect of different access sheaths, working channel instruments, and hydrostatic pressure. J Endourol 24(12):1915–1920CrossRef

16.

Tokas T, Herrmann TRW, Skolarikos A, Nagele U, Training, and Research in Urological Surgery, and Technology (T.R.U.S.T.) Group (2019) Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures. World J Urol. 37(1):133–142CrossRef

17.

Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580–584CrossRef

18.

Monga M, Bodie J, Ercole B (2004) Is there a role for small-diameter ureteral access sheaths? Impact on irrigant flow and intrapelvic pressures. Urology 64(3):439–441CrossRef

19.

Sener TE, Cloutier J, Villa L, Marson F, Butticè S, Doizi S, Traxer O (2016) Can we provide low intrarenal pressures with good irrigation flow by decreasing the size of ureteral access sheaths? J Endourol 30(1):49–55CrossRef

20.

Fang L, Xie G, Zheng Z, Liu W, Zhu J, Huang T, Lu Y, Cheng Y (2019) The effect of ratio of endoscope-sheath diameter on intrapelvic pressure during flexible ureteroscopic lasertripsy. J Endourol 33(2):132–139CrossRef

21.

Wright A, Williams K, Somani B, Rukin N (2015) Intrarenal pressure and irrigation flow with commonly used ureteric access sheaths and instruments. Cent Eur J Urol 68(4):434–438

22.

Mager R, Balzereit C, Reiter M, Gust K, Borgmann H, Hüsch T, Nagele U, Haferkamp A, Schilling D (2015) Introducing a novel in vitro model to characterize hydrodynamic effects of percutaneous nephrolithotomy systems. J Endourol 29(8):929–932CrossRef

23.

Landman J, Venkatesh R, Ragab M, Rehman J, Lee DI, Morrissey KG, Monga M, Sundaram CP (2002) Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath. Urology 60(4):584–587CrossRef

24.

Tepeler A, Akman T, Silay MS, Akcay M, Ersoz C, Kalkan S, Armagan A, Sarica K (2014) Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy. Urolithiasis 42(3):275–279CrossRef

Titel: Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model
verfasst von: Steeve Doizi
Audrey Uzan
Etienne Xavier Keller
Vincent De Coninck
Hatem Kamkoum
Yazeed Barghouthy
Eugenio Ventimiglia
Olivier Traxer
Publikationsdatum: 21.09.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: World Journal of Urology / Ausgabe 7/2021
Print ISSN: 0724-4983
Elektronische ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03450-2

Neu im Fachgebiet Urologie

Patrone im Penis bringt Urologen in Gefahr

30.05.2024 Operationen am Penis Nachrichten

In Lebensgefahr brachte ein junger Mann nicht nur sich selbst, sondern auch das urologische Team, das ihm zu Hilfe kam: Er hatte sich zur Selbstbefriedigung eine scharfe Patrone in die Harnröhre gesteckt.

15% bedauern gewählte Blasenkrebs-Therapie

29.05.2024 Urothelkarzinom Nachrichten

Ob Patienten und Patientinnen mit neu diagnostiziertem Blasenkrebs ein Jahr später Bedauern über die Therapieentscheidung empfinden, wird einer Studie aus England zufolge von der Radikalität und dem Erfolg des Eingriffs beeinflusst.

Costims – das nächste heiße Ding in der Krebstherapie?

28.05.2024 Onkologische Immuntherapie Nachrichten

„Kalte“ Tumoren werden heiß – CD28-kostimulatorische Antikörper sollen dies ermöglichen. Am besten könnten diese in Kombination mit BiTEs und Checkpointhemmern wirken. Erste klinische Studien laufen bereits.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Update Urologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model