Evaluation of the Impact of Ureteroscope, Access Sheath, and Irrigation System Selection on Intrarenal Pressures in a Porcine Kidney Model

MacCraith, Eoin; Yap, Lee Chien; Elamin, Mutaz; Patterson, Kenneth; Brady, Ciaran; Hennessey, Derek

doi:10.1089/end.2020.0838

Cited by 29 publications

(22 citation statements)

References 21 publications

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“…The effect of the ratio of the ureteroscope and the UAS diameter was evaluated by three groups [ 14 , 15 , 16 ]. They found that higher ratios were associated with higher IRP and subsequent increased resistive index in the arcuate artery.…”

Section: Resultsmentioning

confidence: 99%

“…It may be reserved for difficult ureteral access or treatment of stone patients with an increased risk of infectious complications, as well as a possible addition in case of difficult operative conditions with low visibility due to low irrigation fluid outflow. Keeping the ratio of the ureteroscope and the UAS diameter below 0.75 seems an acceptable approach to maintain IRP below the threshold of pyelovenous backflow (40–60 cmH 2 O) when using forced irrigation inflow pressures over 200 cmH 2 O [ 14 , 15 ]. Although, this might be well influenced by the exact position of the proximal end of the UAS in the upper urinary tract [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

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Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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Ureteral access sheaths (UASs) are part of urologist’s armamentarium when performing retrograde intrarenal surgery (RIRS). Recently, the world of RIRS has changed dramatically with the development of three game-changers: thulium fiber laser (TFL), smaller size single use digital flexible ureterosopes and intraoperative intrarenal pressure (IRP) measurement devices. We aimed to clarify the impact of UASs on IRP, complications and SFRs and put its indications in perspective of these three major technological improvements. A systematic review of the literature using the Medline, Scopus and Web of Science databases was performed by two authors and relevant studies were selected according to PRISMA guidelines. Recent studies showed that using a UAS lowers IRP and intrarenal temperature by increasing irrigation outflow during RIRS. Data on the impact of a UAS on SFRs, postoperative pain, risk of infectious complications, risk of ureteral strictures and risk of bladder recurrence of urothelial carcinoma after diagnostic RIRS were inconclusive. Prestenting for at least one week resulted in ureteral enlargement, while the influence of pre-operative administration of alpha-blockers was unclear. Since TFL, smaller single use digital ureteroscopes and devices with integrated pressure-measuring and aspiration technology seemed to increase SFRs and decrease pressure and temperature related complications, indications on the use of a UAS may decrease in the near future.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Coninck

Somani

Şener

et al. 2022

JCM

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show abstract

“…Additionally, irrigation is important for obtaining a clear endoscopic view, and it would be better if the robot is equipped with an automatic and controllable irrigation system. Although commercial irrigation devices exist in the market, they usually work with a manual pump which is pumped by the urologist or assistant for supplemental irrigation 20 . Hence, the robot's built‐in irrigation system allows the urologist to easily control the irrigation and can reduce the number of staff in the operating room.…”

Section: Methodsmentioning

confidence: 99%

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

Shu

Hua

Wang

et al. 2022

Robotics Computer Surgery

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Background: Although some robotic systems have been developed to improve conventional flexible ureteroscopy (FURS), a widely used intervention in urology, these robots rarely have a comprehensive force feedback function which is important for master-slave controlled surgical robots.Methods: Here, we design and fabricate a novel FURS robot with a comprehensive force feedback function. Moreover, to realize better force feedback, a neural network-based method is also demonstrated to estimate the interactive forces between the flexible ureteroscope and the environment. Results:We show that when teleoperating the flexible ureteroscope with our robot, the operator can accurately feel the obstruction if the interactive axial force or torque exceeds 1.2 N or 15.6 mN•m respectively. For bending movement, augmented force feedback greatly improves the accuracy of the operator's perception of obstruction. Conclusions:The developed robotic system with force feedback is expected to improve the safety of robot-assisted FURS.

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“…29,30 The degree of elevation of intrarenal pressure depends on various factors including stone size and location, severity of stone impaction, type of ureteroscope and irrigation system, and size of ureteroscope and UAS. [31][32][33] Maintaining both good endoscopic view and safe intrarenal pressure requires certain measures. The use of UAS could assist in improving the irrigation condition and in preventing the increase of intrarenal pressure.…”

Section: Selection Of Ureteroscope: Semi-rigid Ureteroscope or Flexib...mentioning

confidence: 99%

“…Although intrarenal pressure over 40 mmHg is known to be a risk factor of pyelovenous and pyelolymphatic backflow of irrigation fluid, a recent study showed that very high intrarenal pressure can be generated by using most irrigation devices including by various pumping systems and syringes 29,30 . The degree of elevation of intrarenal pressure depends on various factors including stone size and location, severity of stone impaction, type of ureteroscope and irrigation system, and size of ureteroscope and UAS 31–33 . Maintaining both good endoscopic view and safe intrarenal pressure requires certain measures.…”

Section: Retrograde Urslmentioning

confidence: 99%

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions

et al. 2022

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Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.

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Evaluation of the Impact of Ureteroscope, Access Sheath, and Irrigation System Selection on Intrarenal Pressures in a Porcine Kidney Model

Cited by 29 publications

References 21 publications

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Ureteral Access Sheaths and Its Use in the Future: A Comprehensive Update Based on a Literature Review

Safety enhanced surgical robot for flexible ureteroscopy based on force feedback

Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions

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