Adult urology: editorial commentIs there a role for small-diameter ureteral access sheaths? Impact on irrigant flow and intrapelvic pressures☆
Section snippets
Material and methods
Ureteral access sheaths were tested ex vivo in 12 porcine kidneys. The kidneys, ureter, and bladder were harvested en bloc from pigs (mean weight 38 kg) and studied fresh, immediately after retrieval. The anterior bladder was bivalved, and the ureteral orifices were cannulated with a 0.035 Bentson guidewire.
An 18F angiocatheter was placed in the renal pelvis and connected to a Hewlett Packard Gauss Pressure transducer. Irrigant was maintained at 100 mm Hg pressure by gravity flow. Initially,
Results
The intrapelvic pressures were greater than 40 mm Hg for the Olympus URF-P3 and Storz 11274AAU flexible ureteroscopes, irrespective of which 10F sheath was used (Fig. 1). With the Wolf 7325.172, the intrapelvic pressures were lowest with the Cook Peelaway 10F (22 mm Hg) and Applied Access 10F (16 mm Hg) access sheaths. The irrigant flow was less than 15 mL/min for the Olympus URF-P3 and Storz 11274AAU flexible ureteroscopes, irrespective of which 10F sheath was used (Fig. 2). With the Wolf
Comment
One of the proposed advantages of the use of access sheaths during flexible ureteroscopy is to minimize intrapelvic pressure and maximize irrigant flow. Studies have demonstrated that these effects are superior with 12F internal diameter sheaths compared with 10F internal diameter sheaths.2 However, ureteral access sheath manufacturers continue to produce small-diameter 10F sheaths. In this study we evaluated the utility of 10F sheaths with a variety of flexible ureteroscopes.
New flexible
Conclusions
Small ureteral access sheaths should be used only with the Wolf 7325.172 flexible ureteroscope. The Cook Peelaway (10F) and Applied Access (10F) sheaths offered the greatest increase in irrigant flow and decrease in intrapelvic pressures.
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Comparison of irrigation flows between different irrigation methods for flexible ureteroscopy: An in vitro study
2022, Progres en UrologieCitation Excerpt :Recently, attention has focused on intrarenal pressure and its levels reached during endourological procedures such as f-URS [11–24]. Some factors have been identified to impact it during f-URS such as irrigation pressure, occupation of the working channel, and use of a UAS [12–14,17,18,20–22,24]. However, none of these studies focused on the influence of the method of irrigation on intrarenal pressure.
Safety of the flexible ureteroscopy without ureteral access sheath
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M. Monga is a study investigator funded by Cook, ACMI, Applied Medical, Storz, Wolf, and Olympus and has a patent application with Applied Medical.