Juan-Pablo Caballero-Romeu1, Jua-Antonio Galán-Llopis2, Federico Soria3, Esther Morcillo-Martín3, Pablo Caballero-Pérez4, Alejandro Garcia5, Julia E De La Cruz-Conty3, Jesús Romero-Maroto6,7. 1. Urology Department, University Hospital of Vinalopó, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Carrer Tonico Sansano Mora, 14, Elche, 03293, Alicante, Spain. juanpablocaballero@gmail.com. 2. Urology Department, University Hospital of Vinalopó, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Carrer Tonico Sansano Mora, 14, Elche, 03293, Alicante, Spain. 3. Endoscopy Unit, Jesús Usón Minimally Invasive Surgery Center, Carretera N-521, km. 41,8, 10071, Cáceres, Spain. 4. Community Nursing, Preventive Medicine and Public Health and History of Science Department, University of Alicante, Carretera San Vicente del Raspeig, s/n, San Vicente del Raspeig, 03690, Alicante, Spain. 5. Urology Department, Elche University General Hospital, Camí de l´Almazara, 11, Elche, 03203, Alicante, Spain. 6. Urology Department, San Juan University Clinic Hospital, Ctra. Nnal. 332, s/n, Sant Joan d'Alacant, 03550, Alicante, Spain. 7. Miguel Hernández University, Alicante, Spain.
Abstract
PURPOSE: Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS. METHODS: A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured. RESULTS: The range of average pressures was 5.08-14.1 mmHg in the m-URS group and 6.08-20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001). CONCLUSIONS: m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
PURPOSE: Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS. METHODS: A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured. RESULTS: The range of average pressures was 5.08-14.1 mmHg in the m-URS group and 6.08-20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001). CONCLUSIONS: m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
Authors: Jean de la Rosette; John Denstedt; Petrisor Geavlete; Francis Keeley; Tadashi Matsuda; Margaret Pearle; Glenn Preminger; Olivier Traxer Journal: J Endourol Date: 2013-12-17 Impact factor: 2.942
Authors: Christian Türk; Aleš Petřík; Kemal Sarica; Christian Seitz; Andreas Skolarikos; Michael Straub; Thomas Knoll Journal: Eur Urol Date: 2015-09-04 Impact factor: 20.096