Local and Systemic Effects of Endoluminal Pelvic Perfusion of Isoproterenol: A Dose Response Investigation in Pigs

Abstract

Isoproterenol significantly inhibits the pressure increase due to perfusion in the normal porcine renal pelvis without concomitant cardiovascular side effects. Isoproterenol is a safe drug in this porcine model and, hence, it is potentially useful during endourological procedures.

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

“…Ureteral access sheath also can provide protection against elevated renal pressures during routine ureteroscopic stone surgery [23]. In addition, some documents reported that some β-receptor agonist can cause relaxation of the upper urinary tract and reduce the pelvic pressure, such as β2-agonists and β3-agonists [6,9,11,12,13,14,15,18,19,24,25]. …”

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

“…The pressure reduction may be amplified using higher concentrations of ISO but at the expense of systemic side-effects [9,14]. Relaxation of the upper urinary tract is mediated by activation of b 2 -and b 3 -adrenoceptors in the ureteric wall [12].…”

“…Stimulation of b-adrenoceptors in the ureter mediates smooth muscle relaxation [9,12,15] and, given that the order of relaxation of catecholamines is ISO adrenaline norepinephrine [12], it seems relevant to examine the potential use of ISO. We have previously shown [14] that ISO effectively and dose-dependently inhibits the muscle function of the upper urinary tract in swine, and that a 0.1-mg/ml solution of ISO is effective and safe at a perfusion rate of 8 ml/min.…”

“…Various pharmacological agents have been tested, among which different a-and b-agonists and antagonists have shown great potential for reducing intrarenal pelvic pressure [9Á14]. Both norepinephrine and isoproterenol (ISO), administered endoluminally, significantly decreased the expected pelvic pressure increase during pressureÁflow studies [11,14]. In addition, endoluminal administration seems preferable to systemic administration as cardiovascular side-effects can be avoided [11,14].…”

“…Both norepinephrine and isoproterenol (ISO), administered endoluminally, significantly decreased the expected pelvic pressure increase during pressureÁflow studies [11,14]. In addition, endoluminal administration seems preferable to systemic administration as cardiovascular side-effects can be avoided [11,14]. Stimulation of b-adrenoceptors in the ureter mediates smooth muscle relaxation [9,12,15] and, given that the order of relaxation of catecholamines is ISO adrenaline norepinephrine [12], it seems relevant to examine the potential use of ISO.…”