Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study.

PURPOSE

To evaluate the feasibility of measuring the intrapelvic pressure (IPP) during f-URS with a wire including a pressure sensor and to assess IPP profiles during the procedure.

METHODS

Patients undergoing f-URS for stone disease were recruited. A wire with pressure sensor was placed in the renal cavities to measure IPP. For these cases, either no ureteral access sheath (UAS) or 10/12 or 12/14-Fr UASs were used according to surgeon discretion. Irrigation was ensured by a combination of a continuous pressure generator set at 80 cmHO and a hand-assisted irrigation system providing on-demand forced irrigation to provide proper visibility. Pressures were monitored in real time and recorded for analysis.

RESULTS

Four patients undergoing five f-URS were included. IPP monitoring was successful in all patients. Mean baseline IPP was 6 cmHO. During f-URS with only the endoscope in the renal cavities and irrigation pressure set at 80 cmHO without any forced irrigation, the mean IPP was 63 cmHO. Mean IPP during laser lithotripsy with the use of on-demand forced irrigation was 115.3 cmHO. The maximum pressure peaks recorded during this therapeutic period using forced irrigation ranged from 289.3 to 436.9 cmHO.

CONCLUSION

High IPP levels may be achieved during f-URS with on-demand irrigation systems. The impact of these high pressures on the risk of complications and long-term consequences still need to be evaluated adequately. But, in this preliminary pilot study, IPP could be reliably and conveniently monitored and recorded using a wire with a digital pressure sensor.