Rawandale-Patil Ashish V, Ganpule Arvind P, Patni Lokesh G
Department of Urology, Institute of Urology, Dhule, Maharashtra, India.
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.
Indian J Urol. 2019 Jul-Sep;35(3):197-201. doi: 10.4103/iju.IJU_261_18.
Miniaturized percutaneous nephrolithotomy (mini-PCNL) requires saline irrigation at high-pressures to maintain visual clarity. However, this may raise the intrarenal pelvic pressures (IRPs) beyond a safe range and may result in a higher complication rate. The aim of this study was to make and validate an automated pressure saline irrigation system to regulate IRPs during mini-PCNL.
A ureteric catheter was connected to an urodynamic machine and the minimum, maximum, and average IRPs reached during a standard 15 Fr mini-PCNL were measured in ten cases. Next, an intrarenal pressure regulation system (IPRS) was conceptualized, designed, patented, and constructed. IPRS was then tested on a mannequin model using the routine instruments. Lastly, the IPRS was evaluated on - five cases of 15 Fr mini-PCNL. The mean maximum IRP as recorded in the baseline data was set as the maximum permissible pressure on IPRS. The efficacy of IPRS was assessed by measuring the IRP, recorded in parallel, on both the IPRS and the urodynamic machine at various stages of the procedure.
The mean maximum IRP reached during baseline evaluation was 25 cm of water which was set as the maximum permissible limit of the IPRS. Evaluation of the IRPS on mannequin models and validation clinical cases showed that IPRS measured the IRP accurately and prevented the pressure surge above the set limits Overall, higher IRPs were recorded during stone pulverization as compared to the other surgical steps.
The current IPRS is the first of its kind open platform, portable, automated pressure saline irrigation system. It precisely monitors and controls the IRP and has the potential to reduce the irrigation pressure-related complications.
微创经皮肾镜取石术（mini-PCNL）需要高压盐水冲洗以保持视野清晰。然而，这可能会使肾盂内压力（IRP）升高到安全范围之外，并可能导致更高的并发症发生率。本研究的目的是制作并验证一种自动压力盐水冲洗系统，以在mini-PCNL期间调节IRP。
将输尿管导管连接到尿动力学机器上，测量10例标准15F mini-PCNL过程中达到的最低、最高和平均IRP。接下来，构思、设计、申请专利并构建了一种肾内压力调节系统（IPRS）。然后使用常规器械在人体模型上对IPRS进行测试。最后，在5例15F mini-PCNL病例中对IPRS进行评估。将基线数据中记录的平均最大IRP设定为IPRS上的最大允许压力。通过在手术的各个阶段测量IPRS和尿动力学机器上并行记录的IRP来评估IPRS的疗效。
基线评估期间达到的平均最大IRP为25厘米水柱，被设定为IPRS的最大允许极限。在人体模型和验证临床病例上对IRPS的评估表明，IPRS能够准确测量IRP并防止压力超过设定极限。总体而言，与其他手术步骤相比，碎石过程中记录到的IRP更高。
目前的IPRS是同类产品中首个开放平台、便携式、自动压力盐水冲洗系统。它能精确监测和控制IRP，并有可能减少与冲洗压力相关的并发症。
