Division of Urology, University of Montreal Hospital Center, Montreal, Canada.
Department of Urological Sciences, Stone Centre at Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
BJU Int. 2023 Dec;132(6):678-685. doi: 10.1111/bju.16173. Epub 2023 Sep 16.
To report on our first-in-human experience using the LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) to measure intrarenal pressure (IRP) during flexible ureteroscopy.
A single-arm retrospective observational analysis was performed in 50 consecutive patients undergoing ureteroscopic lithotripsy using the LithoVue Elite™ system with pressure sensing capability between April 2022 and February 2023 at two centres. A pressure bag set at 150 mmHg or hand irrigation with a 60-mL syringe was used for irrigation and a ureteric access sheath (UAS) was placed at the physician's discretion. Median and maximum IRPs, and relative cumulative time exceeding 20, 40, 60, 80, 100, 120, 140, 160, and 200 mmHg per total procedure time were analysed. The two-sample Mann-Whitney U-test was used, with statistical significance set at P < 0.05.
The median (interquartile range [IQR]) patient age and body mass index (BMI) was 62.5 (46.7-68.2) years and 27.6 (23.3-32.1) kg/m , respectively. During the median (IQR) total procedure time of 31.9 (17.4-44.9) min, the median and maximum IRPs were 28.5 (20.0-47.5) and 174.0 (133.5-266.0) mmHg, respectively. IRP remained at <60 mmHg during 92% of the procedure times. Patients with Asian ethnicity, and those without pre-stenting or UAS use exhibited longer cumulative/total durations exceeding pre-defined IRP cut-off values. The smaller 10/12-F UAS did not lower pressures as much as the 11/13-F or 12/14-F UAS (P < 0.001). Age, diabetes, hypertension, preoperative α-blockade, stone size, and BMI did not show any statistically significant associations with IRP.
The IRP can now be routinely measured during ureteroscopy. Patients had a median IRP of 28.5 mmHg and a maximum of 174 mmHg. Using a smaller UAS (10/12 F), Asian ethnicity, and tight ureters were found to have higher IRPs.
报告我们首次使用 LithoVue Elite™输尿管镜（波士顿科学公司，马萨诸塞州马尔伯勒）在柔性输尿管镜检查期间测量肾内压（IRP）的人体经验。
2022 年 4 月至 2023 年 2 月，在两个中心对 50 例连续接受 LithoVue Elite™系统输尿管镜碎石术的患者进行了单臂回顾性观察分析，该系统具有压力感应功能。使用压力袋设定在 150mmHg 或使用 60mL 注射器进行手冲洗，并根据医生的判断放置输尿管接入鞘（UAS）。分析了中位和最大 IRP，以及总手术时间内累计超过 20、40、60、80、100、120、140、160 和 200mmHg 的相对时间。使用两样本曼-惠特尼 U 检验，统计学意义设定为 P<0.05。
中位（四分位距 [IQR]）患者年龄和体重指数（BMI）分别为 62.5（46.7-68.2）岁和 27.6（23.3-32.1）kg/m2。在中位（IQR）总手术时间 31.9（17.4-44.9）分钟期间，中位和最大 IRP 分别为 28.5（20.0-47.5）和 174.0（133.5-266.0）mmHg。在 92%的手术时间内，IRP 保持在<60mmHg。亚洲人种患者和未行预扩张或使用 UAS 的患者，其累计/总持续时间超过预定义的 IRP 截止值的时间更长。较小的 10/12-F UAS 没有像 11/13-F 或 12/14-F UAS 那样降低压力（P<0.001）。年龄、糖尿病、高血压、术前α受体阻滞剂、结石大小和 BMI 与 IRP 无显著相关性。
现在可以在输尿管镜检查期间常规测量 IRP。患者的中位 IRP 为 28.5mmHg，最大为 174mmHg。使用较小的 UAS（10/12F）、亚洲人种和紧张的输尿管会导致更高的 IRP。
