Balawender Krzysztof
Clinical Department of Urology and Urological Oncology, Municipal Hospital in Rzeszow, 35-241 Rzeszow, Poland.
Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Medical College, Rzeszow University, 35-301 Rzeszow, Poland.
J Clin Med. 2023 Apr 21;12(8):3030. doi: 10.3390/jcm12083030.
(I) Introduction: The use of Doppler ultrasound allows us to indirectly assess the effect of increased intrarenal pressure on renal blood flow during retrograde intrarenal surgery (RIRS). On the basis of vascular flow spectra from selected blood vessels in the kidney, it is possible to determine Doppler parameters that reflect the renal perfusion status, which indirectly shows the degree of vasoconstriction and reflects the resistance of kidney tissue. (II) Materials and methods: A total of 56 patients were included in the study. The study assessed the changes of three Doppler parameters of intrarenal blood flow: resistive index-RI, pulsatility index-PI, and acceleration time-AT in the ipsilateral and contralateral kidneys during RIRS. The effects of mean stone volume, energy used, and pre-stenting were examined as predictors and calculated at two time intervals. (III) Results: The mean value of RI and PI was significantly higher in the ipsilateral kidney than in the contralateral kidney just after RIRS. The mean value of the acceleration time was not significantly different before and after RIRS. The values of all three parameters 24 h after the procedure were comparable to their values immediately after the RIRS. The size of the stone exposed to laser lithotripsy, the value of the energy used, and pre-stenting are not factors that significantly influence Doppler parameters during RIRS. (IV) Conclusions: The significant increase in RI and PI after RIRS in the ipsilateral kidney suggests a vasoconstriction of the interlobar arteries generated by increased intrarenal pressure during the procedure.
（I）引言：使用多普勒超声可使我们在逆行性肾内手术（RIRS）期间间接评估肾内压力升高对肾血流的影响。基于肾脏中选定血管的血流频谱，有可能确定反映肾脏灌注状态的多普勒参数，这间接显示了血管收缩程度并反映了肾组织的阻力。（II）材料与方法：共有56例患者纳入本研究。该研究评估了RIRS期间同侧和对侧肾脏肾内血流的三个多普勒参数的变化：阻力指数（RI）、搏动指数（PI）和加速时间（AT）。将平均结石体积、使用的能量和预先置入支架作为预测因素进行研究，并在两个时间间隔进行计算。（III）结果：RIRS刚结束时，同侧肾脏的RI和PI平均值显著高于对侧肾脏。加速时间的平均值在RIRS前后无显著差异。术后24小时所有三个参数的值与RIRS刚结束时的值相当。接受激光碎石术的结石大小、使用的能量值和预先置入支架并非RIRS期间显著影响多普勒参数的因素。（IV）结论：同侧肾脏RIRS后RI和PI显著升高表明手术期间肾内压力升高导致叶间动脉血管收缩。
