Can We Provide Low Intrarenal Pressures with Good Irrigation Flow by Decreasing the Size of Ureteral Access Sheaths?

Şener, Tarık Emre; Cloutier, Jonathan; Villa, Luca; Marson, Francesco; Butticè, Salvatore; Doizi, Steeve; Traxer, Olivier

doi:10.1089/end.2015.0387

Cited by 92 publications

(51 citation statements)

References 14 publications

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“…For the same flexible ureteroscope, intrapelvic pressure increases as UAS size decreases. In summary, small‐sized UASs can provide low intrapelvic pressures with good irrigation inflow and outflow when using a small‐sized flexible ureteroscope .…”

Section: Resultsmentioning

confidence: 94%

“…Vision is enhanced during flexible URS by increasing irrigation inflow. This is achieved by raising the hydrostatic column or irrigation pressure, which subsequently increases the intrapelvic pressure . An option for decreasing the intrarenal pressure is to increase irrigation outflow by using a UAS.…”

Section: Resultsmentioning

confidence: 99%

“…Using wider UAS diameters, irrigation outflow increases in a non‐linear manner when the working channel of the ureteroscope is empty ; however, when instruments occupy the working channel of the ureteroscope, they limit irrigation inflow and therefore there is no advantage in terms of irrigation outflow with increasing UAS diameters.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of ureteral access sheaths: facts and myths

et al. 2018

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The aim of the present paper was to review the literature on all available ureteral access sheaths (UASs) with their indications, limitations, risks, advantages and disadvantages in current modern endourological practice. Two authors searched Medline, Scopus, Embase and Web of Science databases to identify studies on UASs published in English. No time period restriction was applied. All original articles reporting outcomes or innovations were included. Additional articles identified through references lists were also included. Case reports, editorials, letters, review articles and meeting abstracts were excluded. A total of 754 abstracts were screened, 176 original articles were assessed for eligibility and 83 articles were included in the review. Based on a low level of evidence, UASs increase irrigation flow during flexible ureteroscopy and decrease intrapelvic pressure and probably infectious complications. Data were controversial and sparse on the impact of UASs on multiple reinsertions and withdrawals of a ureteroscope, stone-free rates, ureteroscope protection or damage, postoperative pain, risk of ureteral strictures, and also on its cost-effectiveness. Studies on the benefit of UASs in paediatrics and in patients with a coagulopathy were inconclusive. In the absence of good randomized data, the true impact of UASs on surgery outcome remains unclear. The present review may contribute to the evidence-based decision-making process at the individual patient level regarding whether or not a UAS should be used.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

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Systematic review of ureteral access sheaths: facts and myths

et al. 2018

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“…The smaller the ureteroscope, the higher the outflow. This concept has been well illustrated in studies on ureteral access sheaths, which represent another alternative for increased irrigation outflow [12][13][14]. A compensatory rise of irrigation inflow can easily be achieved by increasing pressure of the irrigation fluid attached to the ureteroscope [15], although this should be performed with care since no ureteroscope to date can monitor intrarenal pressure.…”

Section: Impact Of Ureteroscope Size On Irrigation Flowmentioning

confidence: 99%

Which flexible ureteroscope is the best for upper tract urothelial carcinoma treatment?

et al. 2019

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PURPOSE To present attributes of currently available flexible ureteroscopes to define the best flexible ureteroscope for upper tract urothelial carcinoma (UTUC) treatment. MATERIALS AND METHODS Scopus and Medline databases were searched for articles relating to performance of flexible ureteroscopes. A consensus for final inclusion of articles judged to be relevant for UTUC treatment was reached between the authors. Instrument characteristics were extracted from manufacturers' product brochures. RESULTS Smaller cross-sectional size of instruments is associated with increased probability for successful primary access to the upper urinary tract. The smallest flexible ureteroscopes are fiberoptic scopes. Smaller ureteroscopes also allow comparatively increased irrigation flow at constant intrarenal pressure. Digital flexible ureteroscopes achieve superior image quality compared to their fiberoptic counterparts, at the price of lower end-deflection ability. Image enhancement technologies such as narrowband imaging (NBI), photodynamic diagnosis (PDD) and Image 1-S (formerly SPIES) are based on subjective image interpretation by the operator. NBI and PDD significantly increase tumor detection rate. The highest subjective image quality score of the Image 1-S technology is reached by the "Clara + Chroma" mode. Single-use ureteroscopes offer potential advantages over reusable scopes, including sterility, absence of contamination, immediate availability and exemption of previous instrument wear. CONCLUSIONS Miniaturization, digital image caption and image enhancement technologies seem to be the major determinants defining the best flexible ureteroscope for UTUC treatment. The impact of further factors, such as distal tip design, torque, working channel position, risk of contamination, as well as upcoming technological innovations should be evaluated in randomized controlled trials.

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“…Previous experimental studies have explored several clinically important parameters related to RIRS, including intrarenal pressure, intrarenal temperature, irrigation flow pressure, optimal laser mode and utility of surgical instruments (e.g. f‐URS, UAS and stone retrieval baskets) . However, these studies have used different in vitro models and therefore their results cannot be uniformly compared.…”

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confidence: 99%