Irrigation with isoproterenol diminishes increases in pelvic pressure without side-effects during ureterorenoscopy: A randomized controlled study in a porcine model

Jung, Helene; Jakobsen, Jørn Skibsted; Mortensen, J.; Osther, Palle Jørn Sloth; Djurhuus, Jens Christian

doi:10.1080/00365590701520073

Cited by 20 publications

(9 citation statements)

References 21 publications

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“…The use of small‐diameter ureteric access sheaths has been shown to reduce pelvic pressure during ureteroscopy [21,22], but the use of access sheaths requires further instrumentation of the ureter, in contrast to adding a pharmacological agent to the irrigation fluid. We recently showed, in a porcine model, that ISO 0.1 µg/mL significantly reduced the renal pelvic pressure during flexible ureterorenoscopy [23], and this effect was reproducible in humans [24] with no concomitant side‐effects. In this latter study ISO also could not be detected in plasma.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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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.

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Section: Discussionmentioning

confidence: 99%

“…In this latter study ISO also could not be detected in plasma. The mean renal pelvic pressure during endoscopy with ISO perfusion could be held as low as 28 mmHg [23], indicating an endoluminal ISO effect.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…17 ) and that phentolamine has no convincing effect. isoproterenol during flexible ureteroscopy was recently demonstrated in a pig model [23]. The pelvic pressure increase was reduced by 42%, when isoproterenol was added to the irrigation fluid compared to a control group.…”

Section: Discussionmentioning

confidence: 99%

Endoluminal Norepinephrine Inhibits Smooth Muscle Activity of the Pig Pyeloureter by Stimulation of β‐Adrenoceptors without Side Effects

Mortensen¹,

Holst²,

Jakobsen

et al. 2008

Basic Clin Pharma Tox

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It has been demonstrated in pigs that endoluminal administration of norepinephrine reduces the increase in renal pelvic pressure during perfusion. The purposes were to describe concentration-response relationship and receptor mechanism of the effect of norepinephrine on muscle function of pyeloureter and to reveal possible side effects on cardiovascular and renal functions. Renal pelvis was perfused, while pelvic pressure, cardiovascular and renal functional parameters were recorded. In group A, a pelvic pressure increase was examined during pressure flow studies with norepinephrine solutions (0, 1, 5, 50 and 100 μ g/ml). In group B, pelvis was perfused with 6 ml/min. norepinephrine solutions (0, 0.001, 0.01, 0.1 and 1 μ g/ml). In group C, pelvis was perfused with 6 ml/min. norepinephrine, norepinephrine + sotalol 10 -6 mol/l and norepinephrine + phentolamine 10 -6 mol/l. Norepinephrine solutions of 0, 10 -8 , 10 -7 , 10 -6 , 10 -5 and 10 -4 mol/l were used. In group A, all norepinephrine solutions lowered the pelvic pressure increase significantly. Large increases in plasma and urine norepinephrine occurred with 50 and 100 μ g/ml, but cardiovascular and renal functions remained unchanged. In group B, a significant diminishing pelvic pressure increase with all solutions was seen with a significant difference between all solutions. In group C, norepinephrine demonstrated a concentration-response curve with EC 50 between 10 -8 and 10-7 mol/l (10 -7.27 ± 0.40 ). Sotalol had a smooth muscle inhibitory effect on the pyeloureter and inhibited the effect of norepinephrine increasing EC 50 by about a factor 10 (10 -6.40 ± 1.17 ). No convincing effect of phentolamine was observed. Endoluminal norepinephrine probably stimulates β -adrenoceptors and inhibits a renal pelvis pressure increase to perfusion in a dose-related way without side effects. Endoluminal norepinephrine is safe in pigs and may be useful under endoscopy of the pyeloureter.Our previous studies [1,2] have shown that endoluminal norepinephrine diminishes a pressure increase to perfusion in the renal pelvis of the pig. The significant decrease of the pressure flow relationship [3,4] was obtained without systemic side effects [1]. The literature on this topic is sparse. The findings in two other studies [5,6] apparently are in contrast with ours, but the explanation may purely be differing experimental conditions. Selmy et al .[5] perfused renal pelvis with norepinephrine at a concentration of 100 μ g/ml using a flow rate of 2 ml/min. and found some increases in pelvic pressure and ureteral peristaltic frequency. Danuser et al . [6] perfused renal pelvis with phenylepinephrine at concentrations of 0.1-3 mg/ml using a flow rate of 0.5 ml/min. and found increased peristaltic frequency and amplitude in the mid-portion of the ureter. We used unphysiological high flow rates [1,2] to examine the effect of norepinephrine while performing a provocative test of the pyeloureter, and we found that the weakest norepinephrine concentration of 5 μ g/ml exerts a m...

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“…Primarily, pharmacologic agents have been examined with regard to their potential effect on ureteral and pelvic smooth muscle activity [26,27]. However, intravenously administered adrenergic agents result in frequent cardiovascular side effects when possessing a convincing pressure-modulating capacity [25,27].…”

Section: Discussionmentioning

confidence: 99%

Verapamil Inhibits the Pelvic Pressure Increase Corresponding to Flow Perfusion in the Porcine Percutaneous Renal Puncture Model

Shao¹,

Wei²,

M³

et al. 2016

Urol Int

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Purpose: To estimate the effects of verapamil on pelvic pressure and investigate the possible systemic side effects in the porcine model during the procedure of increasing perfusion rates. Materials and Methods: In the experimental group, the pelvic pressure was recorded with increasing perfusion rates of the renal pelvis (0, 2, 4, 6, 8, 10, 14 and 20 ml/min) in response to intraluminal administration of increasing concentrations of verapamil (0, 0.1, 1, 10 and 100 µg/ml) in isotonic saline. In the isotonic saline group, the pressure flow study was also done by increasing perfusion rates of the renal pelvis per animal using isotonic saline without verapamil. Results: Perfusion with 1, 10 and 100 µg/ml verapamil caused a decrease in pelvic pressure as a response to increasing flow rates, whereas perfusion with 0.1 µg/ml verapamil did not obviously inhibit the increase of pelvic pressure at all perfusion rates compared with other concentrations. Importantly, the mean systolic blood pressure and mean heart rate were stable despite the increase of flow rates and verapamil concentrations. In the isotonic saline group, perfusion with isotonic saline resulted in an increase in the pelvic pressure with an increase in flow rates each time. Conclusions: Endoluminal administration of verapamil reduces pelvic pressure significantly without any untoward systemic cardiovascular side effects.

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Irrigation with isoproterenol diminishes increases in pelvic pressure without side-effects during ureterorenoscopy: A randomized controlled study in a porcine model

Abstract: ISO (0.1 microg/ml) added to irrigation fluid significantly reduces the increase in pelvic pressure during ureterorenoscopy in pigs, without concomitant side-effects.

Cited by 20 publications

References 21 publications

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

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

Endoluminal Norepinephrine Inhibits Smooth Muscle Activity of the Pig Pyeloureter by Stimulation of β‐Adrenoceptors without Side Effects

Verapamil Inhibits the Pelvic Pressure Increase Corresponding to Flow Perfusion in the Porcine Percutaneous Renal Puncture Model

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