Wright Anna, Williams Kevin, Somani Bhaskar, Rukin Nicholas
University Hospital Southampton NHS Trust, Department of Urology, Southampton, United Kingdom.
University Hospital Southampton, Department of Urology, Southampton, United Kingdom.
Cent European J Urol. 2015;68(4):434-8. doi: 10.5173/ceju.2015.604. Epub 2015 Nov 2.
Flexible ureterorenoscopy is becoming a first-line treatment for many intrarenal stones. Ureteric access sheaths are commonly used to aid access, stone removal and reduce intrarenal pressure. We evaluated the effects of two commonly used access sheaths on irrigation flow and intrarenal pressure during flexible ureterorenoscopy. We measured the effect of scope instrumentation on flow and pressure.
We utilized a 10/12F and 12/14F, 35 cm Re-Trace™ access sheath with a FlexX2 scope in a cadaveric porcine kidney. We evaluated the effect of four Nitinol baskets (1.3F, 1.5F, 1.9F, 2.2F), three different 200 µm laser fibres and a hand-held pump. Measurements of irrigation flow and intrarenal pressure were recorded and compared between the different sized access sheaths.
Flow rates varied widely between access sheaths. Without instrumentation, mean flow was 17 mls/min (10/12F access sheath), versus 33 mls/min (12/14F sheath) (p <0.0001). Increasing basket size produced a gradual reduction in flow and pressure in both access sheaths. Reassuringly, pressures were low overall (<40 cm H2O). Pressures were significantly reduced when using the larger 12/14F sheath, with and without all instrumentations (p <0.0001). Hand-held pump devices have a marked effect on flow and pressure in both sheaths; with pressures rising up to 121 cm H2O with a 10/12F sheath, versus 29 cm H2O (12/14F) (p <0.0001).
A 12/14F access sheath offered significantly improved irrigation whilst maintaining significantly lower intrarenal pressure, when compared to a 10/12F access sheath in a cadaveric porcine model. Scope instrumentation affects irrigation flow and pressure in both sized sheaths. Furthermore, there should be caution with hand-held pump devices, especially with smaller sized sheaths, as intrarenal pressure can be very high.
软性输尿管肾镜检查正成为许多肾内结石的一线治疗方法。输尿管通路鞘通常用于辅助进入、结石清除并降低肾内压力。我们评估了两种常用通路鞘在软性输尿管肾镜检查期间对冲洗液流量和肾内压力的影响。我们测量了镜身器械对流量和压力的影响。
我们在一具猪尸体肾脏中使用了10/12F和12/14F、35厘米的Re-Trace™通路鞘以及FlexX2镜身。我们评估了四种镍钛合金取石篮（1.3F、1.5F、1.9F、2.2F）、三种不同的200微米激光光纤和一个手持式灌注泵的影响。记录并比较了不同尺寸通路鞘之间的冲洗液流量和肾内压力测量值。
通路鞘之间的流速差异很大。在未使用器械时，平均流量为17毫升/分钟（10/12F通路鞘），而12/14F鞘为33毫升/分钟（p<0.0001）。增加取石篮尺寸会使两种通路鞘的流量和压力逐渐降低。令人放心的是，总体压力较低（<40厘米水柱）。无论有无所有器械，使用较大的12/14F鞘时压力均显著降低（p<0.0001）。手持式灌注泵装置对两种鞘的流量和压力均有显著影响；使用10/12F鞘时压力升至121厘米水柱，而12/14F鞘为29厘米水柱（p<0.0001）。
在猪尸体模型中，与10/12F通路鞘相比，12/14F通路鞘在显著降低肾内压力的同时，冲洗效果显著改善。镜身器械会影响两种尺寸鞘的冲洗液流量和压力。此外，对于手持式灌注泵装置应谨慎使用，尤其是较小尺寸的鞘，因为肾内压力可能会非常高。
