The Effect of Irrigation Power and Ureteral Access Sheath Diameter on the Maximal Intra-Pelvic Pressure During Ureteroscopy: <i>In Vivo</i> Experimental Study in a Live Anesthetized Pig

Noureldin, Yasser A.; Kallidonis, Panagiotis; Ntasiotis, P.; Adamou, Constantinos; Zazas, Evangelos; Liatsikos, Evangelos

doi:10.1089/end.2019.0317

Cited by 69 publications

(45 citation statements)

References 18 publications

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“…Pathology studies have shown that even at moderately elevated intrarenal pressures, kidney injury, arterial blood flow reduction, and cellular damage is evident at one hour post intrarenal pressure increase; an increase in incidence of post-operative fever and sepsis have also been documented [28,31]. From these studies, sub-20 cm H 2 O intrarenal pressures can be achieved only with the larger diameter UASs (>12/14 Fr).…”

Section: Intrarenal Pressure Reduction and Uas Placementmentioning

confidence: 99%

“…Progressive reductions in intrarenal pressure was shown to be associated with increasing the diameter of UAS [25]. Although studies have shown that UAS placement is promising in decreasing intrarenal pressures in ex-vivo models, the results from an in-vivo porcine study by Noureldin et al [31] showed such intrarenal pressure reduction from UAS placement may not translate. Although it was found that normal physiological intrarenal pressures were achievable by UAS sizes 12/14 Fr and greater under gravity irrigation, only the 14/16 Fr UAS was able to achieve similar results under pressure irrigation with a manual pump.…”

Section: Intrarenal Pressure Reduction and Uas Placementmentioning

confidence: 99%

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Controversies associated with ureteral access sheath placement during ureteroscopy

et al. 2020

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The use of ureteral access sheaths (UAS) is common practice during routine flexible ureteroscopy procedures. However, debates and concerns continue amongst endourologists on routine UAS placement. UAS placement allows for multiple passages of the ureteroscope, decreases intrarenal pressure, and may improve stone-free rates. However, concerns for the UAS's effectiveness in these claimed benefits and complications related to UAS placement has been documented and investigated by many. In this review, we will discuss the controversies surrounding the placement of UAS during ureteroscopy.

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Section: Intrarenal Pressure Reduction and Uas Placementmentioning

confidence: 99%

Section: Intrarenal Pressure Reduction and Uas Placementmentioning

confidence: 99%

Controversies associated with ureteral access sheath placement during ureteroscopy

et al. 2020

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“…Though intermittent normal saline irrigation by hand-held syringe during Ho:YAG laser lithotripsy, there will be no renal injury when the RPP was maintained under 120 cmH 2 O (around 88 mmHg) [22]. In a recent porcine experimental study, under gravity irrigation and manual pumping, the maximal RPP during URS reached 30 and 105 cmH 2 O, respectively, which were all lower than 120 cnH 2 O [8]. Therefore, in our current study, the uNGAL level on Day 14 in ureteral stone group was significantly lower than both the ureteral stricture group and PCNL group.…”

Section: Discussionmentioning

confidence: 99%

“…With advances in technology, ureterorenoscopy (URS) have evolved to a significantly smaller outer diameter. Good irrigation is vital for ureteral dilatation and instrument passage, and irrigation is required to provide a clear vision [8]. However, application of high-pressure irrigation during URS can cause accumulation of renal intrapelvic fluid and increases in intrapelvic pressure significantly [8].…”

Section: Introductionmentioning

confidence: 99%

“…Good irrigation is vital for ureteral dilatation and instrument passage, and irrigation is required to provide a clear vision [8]. However, application of high-pressure irrigation during URS can cause accumulation of renal intrapelvic fluid and increases in intrapelvic pressure significantly [8]. High-pressure irrigation during URS can cause irreversible damage to the urothelium and renal parenchyma [9, 10].…”

Section: Introductionmentioning

confidence: 99%

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Ureterorenoscopic (URS) lithotripsy and balloon dilation cause acute kidney injury and distal renal tubule damage

Huang

Liu

2021

Preprint

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Ureterorenoscopy (URS) is believed to be a safe and effective procedure to treat ureteral stone or ureteral stricture. Rapidly increased intrarenal pressure during URS may have a negative impact on the kidney, but the effect on renal functions is not well known. The aim of this study is to evaluate whether URS balloon dilation or lithotripsy would cause acute kidney injury (AKI), which was evaluated by urine neutrophil gelatinase associated lipocalin (NGAL) and renal tubular damage, which was evaluated by urine α glutathione S-transferase (GST) and πGST. This prospective study consisted of 207 patients with mean age 53.8 years old between September 2012 and June 2013. Four groups were included: the ureteral stricture group (group 1), the ureteral stone group (group 2), and two control groups. URS induced increased uNGAL on both Days 1 and 14 in both groups, and only elevated u-πGST levels were noted on Day 14 after URSL. On Day 14, the difference between low-grade and high-grade hydronephrosis was significant in group 1 (p < 0.001) rather than group 2 (p = 0.150). By multivariate logistic regression analysis, age, baseline eGFR, and stone size > 1.0 cm were associated with complete recovery of hydronephrosis after URS on Day 14. Ureteral stone patients with preserved renal function suffered more AKI (uNGAL) than those with impaired renal function. However, URS-related AKI had no significant difference between stone ≤ 1 cm and > 1 cm subgroups. Besides, urine αGST and πGST were both significantly higher in stone > 1 cm subgroup when compared to ≤ 1 cm subgroup. In conclusion, URS laser lithotripsy and balloon dilatation all resulted in AKI and renal tubular damage on Day 14 though post-URS double-J (DBJ) stenting was performed in every patient.

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Intra-renal Pressure

Riedinger,

Osther,

Knudsen

2023

Percutaneous Renal Surgery

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The Effect of Irrigation Power and Ureteral Access Sheath Diameter on the Maximal Intra-Pelvic Pressure During Ureteroscopy: In Vivo Experimental Study in a Live Anesthetized Pig

Cited by 69 publications

References 18 publications

Controversies associated with ureteral access sheath placement during ureteroscopy

Controversies associated with ureteral access sheath placement during ureteroscopy

Ureterorenoscopic (URS) lithotripsy and balloon dilation cause acute kidney injury and distal renal tubule damage

Intra-renal Pressure

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