Endoluminal isoproterenol reduces renal pelvic pressure during semirigid ureterorenoscopy: a porcine model

Abstract

were recorded. The increase in renal pelvic pressure was examined with increasing flow rates (0, 4, 8,12,16, 25 and 33 mL/min) with saline alone or saline + ISO 0.1 μ g/mL. Perfusion was initiated on the left side, with randomization for adding ISO or not. Thereafter perfusion was done on the right side as a control in each pig. The surgeons were unaware of whether ISO was added or not. RESULTSThe mean ( SD ) baseline pelvic pressures in the saline and ISO group were 28 (7.1) and 25 (9.8) mmHg, respectively, with no significant difference ( P = 0.079). Endoluminal perfusion with ISO significantly inhibited the pelvic pressure increase to perfusion at all perfusion rates. The pressureflow relation was linear; the maximum relaxation (27%) was obtained at 4 mL/min, from 52 to 38 mmHg during saline alone and ISO 0.1 μ g/mL perfusion, respectively. The mean blood pressure did not change significantly ( P = 0.330). The mean ( SD ) heart rate in the saline and ISO group were 109 (4.5) and 97 (2.1) beats/min, respectively ( P < 0.001), i.e. a markedly greater rate in the saline than in the ISO group. CONCLUSIONThe pressure-flow relation during semirigid ureterorenoscopy was linear. ISO 0.1 μ g/mL in saline significantly reduced the pressure-flow relation during semirigid ureterorenoscopy in this porcine model. ISO might be a potential additive to the irrigation fluid during upper urinary tract endoscopic procedures, minimizing pressure increases due to irrigation and manipulation. KEYWORDSisoproterenol, pelvic pressure, endoluminal perfusion, ureterorenoscopy, cardiovascular function OBJECTIVETo investigate the effects on the pressureflow relation of renal pelvic pressure during semirigid ureterorenoscopy and endoluminal perfusion of isoproterenol (ISO) 0.1 μ g/mL, with emphasis on local effects and cardiovascular side-effects, as topically administered ISO effectively and dosedependently causes relaxation of the upper urinary tract in pigs with no concomitant cardiovascular side-effects.

Intraluminal pressure profiles during flexible ureterorenoscopy

“…The trend of extensive pressure rises significantly decreased during isoprenalin irrigation, and the average pressure remained below the level of intrarenal back flow. Similar results were obtained in an experimental swine study showing that isoprenalin significantly reduced the pressure-flow relation during semirigid ureterorenoscopy (Jakobsen et al 2010 ).…”

Clinical Efficacy, Safety, and Costs of Percutaneous Occlusive Balloon Catheter-Assisted Ureteroscopic Lithotripsy for Large Impacted Proximal Ureteral Calculi: A Prospective, Randomized Study

“…24 Studies demonstrated that the use of intraluminal isoproterenol could reduce pelvic pressure by relaxing ureteral tone during endoscopy. 25,26 In our study, the complete occlusive nature of the 8F balloon catheter could prevent the irrigant from flowing proximal to the balloon when it was dilated, and the balloon was deflated per 20 minutes to drain the pelvis and to reduce the intrarenal pressure to the lowest level. Only 1.92% (1/52) patients undergoing POBC-URSL had postoperative fever.…”

The clinical efficacy of novel vacuum suction ureteroscopic lithotripsy in the treatment of upper ureteral calculi

“…For patients who fail to place the sheaths, placing the D-J stent for 2 weeks is suggested. Secondly, although vacuum suction devices can signi cantly reduce the renal pelvic pressure [15], there is a lack of effective devices to monitor the real-time changes of the suction force and renal pelvic pressure [16]. Therefore, it is necessary for the surgeon to be experienced and to arrive at an effective judgment of the lithotripsy procedure.…”