Medición de la presión intrarrenal durante la ureterorrenoscopia (URS) flexible: antecedentes históricos, innovaciones tecnológicas y perspectivas de futuro / How to measure intra-renal pressure during flexible URS: historical background, technological innovations and future perspectives

Introducción La presión intrarrenal (PIR) alta es un factor de riesgo de complicaciones infecciosas relacionadas con la ureterorrenoscopia (URS). Aunque diversos métodos han sido descritos para reducir la PIR, todavía no es posible evaluar los valores de PIR en tiempo real durante la URS. El objetivo de este estudio es llevar a cabo una revisión sistemática de la bibliografía relativa a los métodos endoscópicos para la medición de la PIR durante la URS. Métodos Se llevó a cabo una búsqueda y revisión sistemática en Medline, PubMed y Scopus, de acuerdo con la declaración Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA), y se redactó una síntesis narrativa de los resultados del estudio. Resultados La investigación abarcó un total de 19 artículos. En ellos se presentaban cuatro métodos no invasivos (es decir, endoscópicos) para medir la PIR: catéter ureteral, cable sensor, sistema de irrigación con sensor de presión integrado, y una novedosa vaina de acceso ureteral que integra succión, irrigación y medición de la PIR. Conclusiones El presente documento proporciona una visión global de los sistemas de medición clínica de la PIR durante la URS existentes. Aún no se ha desarrollado un sistema óptimo, pero pronto los urólogos podrán medir la PIR en su práctica diaria. Las implicaciones de esta información durante la cirugía aún se desconocen. Los sistemas capaces de integrar irrigación y succión con monitoreo de PIR y temperatura parecen ser los mejores. (AU)

Introduction High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. Methods A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. Results A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. Conclusions We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal. (AU)

How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives.

INTRODUCTION: High intrarenal pressure (IRP) is a potential risk factor for infectious complications related to URS. Methods to lower IRP have been described. However, it is still not possible to assess live IRP values during URS. The objective of this study was to perform a systematic review of the literature regarding endoscopic methods to measure IRP during URS. METHODS: A systematic search and review of Medline, PubMed and Scopus was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta Analysis (PRISMA) checklist and a narrative synthesis of the study results was performed. RESULTS: A total of 19 articles were included in the review. Four non invasive (i.e. endoscopic) methods to measure IRP were reported: ureteral catheter, sensor wire, pressure sensor proximal to an irrigation system and a novel ureteral access sheath that integrates suction, irrigation, and IRP measurement. CONCLUSIONS: We provide here a comprehensive overview of the reported clinical measuring systems of IRP during URS. The ideal system has not been developed yet, but urologists will be able to measure IRP during their daily practice soon. The implications of having this type of data during surgery remains unknown. Systems that could integrate irrigation, suction, IRP and temperature seems to be ideal.

Ultra-Mini Percutaneous Nephrolithotomy (UMP) with Strict Lower Irrigation Pressure Control: Correlation with Post Operative Febrile Urinary Tract Infection Rate.

BACKGROUND: Ultra-mini PCNL (UMP) is a device that removes stones by using 7.5 Fr. nephroscope and 11/12 Fr. working sheath. The stone free rate (SFR) does not lag behind the convetional PCNL, but due to the diameter of the small device, UMP has many disadvantages; Irrigation pressure increases easily during surgery and post operative febrile urinary tract infection (UTI) is relative common. The purpose of this study is to present the surgical results of UMP with strict irrigation pressure control using a pressure control irrigator. METHODS: 70 consecutive patients who underwent UMP surgery for kidney stones were enrolled retrospectively. All surgeries proceeded with the shoulder rotated supine position. Of these, initial 35 patients underwent surgery using 100 mmHg irrigation power previously and later 35 patients underwent surgery below 40 mmHg irrigation power. RESULTS: The stone size of the UMP 100 mmHg group was 2.52 ± 1.05 and that of the UMP 40 mmHg group was 2.79 ± 1.32 respectively. Operative time was also slightly shorter in the UMP 40 mmHg group, but there was no statistical difference between the two groups. There was no statistical difference in stone free rate, but UMP 100 mmHg group showed 37.1% of post operative febrile urinary tract infection rate and 11.4 % in UMP 40 mmHg group and they are significantly different (p = 0.039). CONCLUSIONS: Strict irrigation pressure control below 40 mm during UMP can reduce post operative febrile UTI without affecting SFR.

Ultra-Mini Percutaneous Nephrolithotomy (UMP) with Strict Lower Irrigation Pressure Control: Correlation with Post Operative Febrile Urinary Tract Infection Rate

Background: Ultra-mini PCNL (UMP) is a device that removes stones by using 7.5 Fr. nephroscope and 11/12 Fr. working sheath. The stone free rate (SFR) does not lag behind the convetional PCNL, but due to the diameter of the small device, UMP has many disadvantages; Irrigation pressure increases easily during surgery and post operative febrile urinary tract infection (UTI) is relative common. The purpose of this study is to present the surgical results of UMP with strict irrigation pressure control using a pressure control irrigator. Methods: 70 consecutive patients who underwent UMP surgery for kidney stones were enrolled retrospectively. All surgeries proceeded with the shoulder rotated supine position. Of these, initial 35 patients underwent surgery using 100 mmHg irrigation power previously and later 35 patients underwent surgery below 40 mmHg irrigation power. Results: The stone size of the UMP 100 mmHg group was 2.52 ± 1.05 and that of the UMP 40 mmHg group was 2.79 ± 1.32 respectively. Operative time was also slightly shorter in the UMP 40 mmHg group, but there was no statistical difference between the two groups. There was no statistical difference in stone free rate, but UMP 100 mmHg group showed 37.1% of post operative febrile urinary tract infection rate and 11.4 % in UMP 40 mmHg group and they are significantly different (p = 0.039). Conclusions: Strict irrigation pressure control below 40 mm during UMP can reduce post operative febrile UTI without affecting SFR (AU)

Role of Intrarenal Pressure in Modern Day Endourology (Mini-PCNL and Flexible URS): a Systematic Review of Literature.

PURPOSE OF REVIEW: To review the latest evidence about intrarenal pressures (IRPs) generated during flexible ureteroscopy (fURS) and mini percutaneous nephrolithotomy (mPCNL) and present tools and techniques to maintain decreased values. RECENT FINDING: fURS and PCNL constitute the primary means of stone treatment. New flexible ureterorenoscopes with small diameter and miniaturized PCNL instruments achieve optimal stone-free rates (SFRs) while decreasing invasiveness and morbidity. Nevertheless, endourologists must remain cognizant regarding the dangers of increased IRPs to avoid complications. Current research presents essential information for urologists regarding this topic. During fURS, using a ureteral access sheath (UAS), we avoid extremely high IRPs with all irrigation types. During mPCNL, pressure remains low, mainly using the purging effect or a vacuum-assisted sheath. Devices of intraoperative IRP measurement and intelligent pressure control have proven their feasibility, accuracy and efficacy. These will have an increasing role to play in the future management of stone disease.

Which has more complications?-Shockwave lithotripsy versus endoscopic treatment of renal calculi with 1-year follow-up in an Australian population.

Introduction and objectives: Renal calculi are a common medical problem with incidence rates calculated to be approximately 6%-9% in men & 3%-4% in women worldwide. Incidence appears to be increasing. This study compares emergency presentations and unplanned readmissions between extracorporeal shock wave lithotripsy (SWL) and pyeloscopic stone treatment in the population of Victoria, Australia after 1-year follow-up. Methods: This is a population study comparing all patients with renal calculi electively treated with SWL to those initially treated with flexible ureteroscopy (URS) in Victoria, Australia. We used data linkage across the state of Victoria to follow patients treated with either modality in a 12 months period (with no urological surgery in the prior 12 months). Each patient's emergency presentations and subsequent re-admissions were followed up for 1 year after their index treatment to assess for stone complications. We assessed for selection bias between the two patient groups by comparing age, gender, insurance status, geographical location, and comorbidity scores. Results: We report stone-related complications for 739 flexible URS and 1317 SWL procedures undertaken across public and private hospitals in Victoria over 12 months. Unplanned emergency presentations within 60-days of surgery were (22/739) 2.98% for flexible URS patients and (83/1317) 6.30% for SWL patients (P = .001); however, at 12 months, this became 16.23% (120/739) for flexible URS patients and 12.83% (169/1317) for SWL patients (P = .034). Flexible URS patients were more likely than SWL patients to be admitted with 71.76% of flexible URS versus 53.97% of SWL patients requiring an admission at any given emergency presentation (P ≤ .001) within 12 months. On multivariate analysis, both flexible URS ([OR] 1.67, CI 1.23-2.26, P = .001) and being a public patient ([OR] 3.06, CI 2.24-4.18, P < .001) significantly increased the likelihood that patients required an unplanned re-admission within 12 months. Conclusions: There is work needed to reduce emergency presentations and unplanned re-admissions after both SWL and flexible URS. At 12-months follow-up, unplanned emergency visits and re-admission rates were significantly more after flexible URS. Symptoms at emergency presentation indicate that better education regarding stent management is needed, especially in the public health care system.

A novel robotic system for flexible ureteroscopy.

BACKGROUND: Interventional robots currently exist for flexible ureteroscopy (fURS). However, force feedback and intra-renal pressure, which are important in fURS, were rarely considered when designing these robots. METHODS: We propose a novel robotic system for fURS integrated with partial force feedback function that is the bending knob's torque feedback of the flexible ureteroscope, and intra-renal pressure monitoring. The proposed robotic system adopts commercial haptic device to realize torque feedback. In addition, we further propose a neural network-based method to optimize the operation of above haptic device. RESULTS: Experimental results show that the slave robot can capture the variation of bending conditions and feedback to the operator, and can also accurately monitor the intra-renal pressure. Besides, the neural network-based method shows its potential in improving the operation. CONCLUSIONS: The results confirm the feasibility of proposed robot's functions. In vivo experiments are needed to further evaluate this system in future work.