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World J Urol ; 36(5): 811-817, 2018 May.
Article in English | MEDLINE | ID: mdl-29372357

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.


Subject(s)
Kidney , Miniaturization/methods , Postoperative Complications , Ureteroscopy , Urolithiasis/surgery , Animals , Disease Models, Animal , Female , Hemodynamics , Intra-Abdominal Hypertension/etiology , Intra-Abdominal Hypertension/prevention & control , Kidney/blood supply , Kidney/diagnostic imaging , Kidney/physiopathology , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/instrumentation , Minimally Invasive Surgical Procedures/methods , Models, Anatomic , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Regional Blood Flow , Swine , Treatment Outcome , Ureteroscopy/adverse effects , Ureteroscopy/instrumentation , Ureteroscopy/methods
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