Department of Urology and Andrology, General Hospital Hall I.T, Milser Str. 10, 6060, Hall i.T., Hall in Tirol, Austria.
Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group, Hall in Tirol, Austria.
Curr Urol Rep. 2021 Oct 8;22(10):52. doi: 10.1007/s11934-021-01067-5.
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.
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.
回顾在软性输尿管镜检查（fURS）和微经皮肾镜取石术（mPCNL）期间产生的肾内压（IRP）的最新证据，并介绍维持降低的压力值的工具和技术。
fURS 和 PCNL 是结石治疗的主要手段。新型小直径软性输尿管镜和微型经皮肾镜器械实现了最佳的无石率（SFR），同时降低了侵袭性和发病率。然而，腔内泌尿外科医生必须意识到增加的 IRP 的危险，以避免并发症。目前的研究为泌尿科医生提供了关于这一主题的重要信息。在 fURS 中，使用输尿管接入鞘（UAS），我们避免了所有冲洗类型的极高 IRP。在 mPCNL 中，压力保持较低，主要使用冲洗效应或真空辅助鞘。术中 IRP 测量和智能压力控制的设备已经证明了它们的可行性、准确性和疗效。这些在未来结石病的管理中将发挥越来越重要的作用。
