Steeve Doizi1,2, Audrey Uzan3,4, Etienne Xavier Keller3,4,5, Vincent De Coninck3,4,6, Hatem Kamkoum3,4, Yazeed Barghouthy3,4, Eugenio Ventimiglia3,4,7, Olivier Traxer3,4. 1. Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France. steeve.doizi@aphp.fr. 2. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. steeve.doizi@aphp.fr. 3. Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France. 4. Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. 5. Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 6. Department of Urology, AZ Klina, Brasschaat, Belgium. 7. Division of Experimental Oncology/Unit of Urology, URI-Urological Research Institute, IRCCS Ospedale San Raffaele, 20132, Milan, Italy.
Abstract
PURPOSE: To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model. METHODS: A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH2O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr. RESULTS: f-URS: IPP values ranged between 1.4 and 46.2 cmH2O. Factors reducing IPP were an irrigation pressure at 40 cmH2O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH2O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH2O. Factors reducing IPP were irrigation pressure at 40 cmH2O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH2O, while it decreased at 193 cmH2O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH2O. Occupancy of the working channel did not affect IPP at 40 cmH2O, while it increased at 193 cmH2O. CONCLUSION: We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH2O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH2O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.
PURPOSE: To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model. METHODS: A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH2O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr. RESULTS: f-URS: IPP values ranged between 1.4 and 46.2 cmH2O. Factors reducing IPP were an irrigation pressure at 40 cmH2O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH2O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH2O. Factors reducing IPP were irrigation pressure at 40 cmH2O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH2O, while it decreased at 193 cmH2O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH2O. Occupancy of the working channel did not affect IPP at 40 cmH2O, while it increased at 193 cmH2O. CONCLUSION: We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH2O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH2O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.