Royal College of Surgeons Ireland (Strategic Academic Recruitment [StAR] Programme), Dublin, Ireland.
Department of Urology, Blackrock Clinic, Dublin, Ireland.
BJU Int. 2024 Nov;134(5):826-833. doi: 10.1111/bju.16497. Epub 2024 Aug 6.
To assess human in vivo intrarenal pressure (IRP) and peristaltic activity at baseline and after ureteric stent placement, using a narrow calibre pressure guidewire placed retrogradely in the renal pelvis.
A prospective, multi-institutional study recruiting consenting patients undergoing ureteroscopy was designed with ethical approval. Prior to ureteroscopy, the urinary bladder was emptied and the COMET™ II pressure guidewire (Boston Scientific) was advanced retrogradely via the ureteric orifice to the renal pelvis. Baseline IRPs were recorded for 1-2 min. At procedure completion, following ureteric stent insertion, IRPs were recorded for another 1-2 min. Statistical analysis of mean baseline IRP, peristaltic waveforms and frequency of peristaltic contractions was performed, thereby analysing the influence of patient variables and ureteric stenting.
A total of 100 patients were included. Baseline mean (±SD) IRP was 16.76 (6.4) mmHg in the renal pelvis, with maximum peristaltic IRP peaks reaching a mean (SD) of 25.75 (17.9) mmHg. Peristaltic activity generally occurred in a rhythmic, coordinated fashion, with a mean (SD) interval of 5.63 (3.08) s between peaks. On univariate analysis, higher baseline IRP was observed with male sex, preoperative hydronephrosis, and preoperative ureteric stenting. On linear regression, male sex was no longer statistically significant, whilst the latter two variables remained significant (P = 0.004; P < 0.001). The mean (SD) baseline IRP in the non-hydronephrotic, unstented cohort was 14.19 (4.39) mmHg. Age, α-blockers and calcium channel blockers did not significantly influence IRP, and no measured variables influenced peristaltic activity. Immediately after ureteric stent insertion, IRP decreased (mean [SD] 15.18 [5.28] vs 16.76 [6.4] mmHg, P = 0.004), whilst peristaltic activity was maintained.
Human in vivo mean (SD) baseline IRP is 14.19 (4.39) mmHg in normal kidneys and increases with both hydronephrosis and preoperative ureteric stenting. Mean (SD) peristaltic peak IRP values of 25.75 (17.9) mmHg are reached in the renal pelvis every 3-7 s and maintained in the early post-stent period.
使用逆行放置在肾盂中的细口径压力导丝，评估输尿管支架置入前后人体肾脏内压（IRP）和蠕动活动。
这项前瞻性、多机构研究招募了同意接受输尿管镜检查的患者，研究设计得到了伦理批准。在输尿管镜检查之前，排空膀胱，并通过输尿管口将 COMET™ II 压力导丝（波士顿科学公司）逆行推进至肾盂。记录 1-2 分钟的基线 IRP。在手术完成时，插入输尿管支架后，再记录 1-2 分钟的 IRP。对平均基线 IRP、蠕动波形和蠕动收缩频率进行统计分析，从而分析患者变量和输尿管支架置入的影响。
共纳入 100 例患者。肾盂内基线平均（±SD）IRP 为 16.76±6.4mmHg，最大蠕动 IRP 峰值达到 25.75±17.9mmHg。蠕动活动通常以有节奏、协调的方式发生，峰值之间的平均（SD）间隔为 5.63±3.08 秒。单变量分析显示，男性、术前肾积水和术前输尿管支架置入与较高的基线 IRP 相关。线性回归显示，男性不再具有统计学意义，而后两个变量仍然具有统计学意义（P=0.004；P<0.001）。非肾积水、未置管队列的平均（SD）基线 IRP 为 14.19±4.39mmHg。年龄、α 受体阻滞剂和钙通道阻滞剂对 IRP 无显著影响，且无测量变量影响蠕动活动。输尿管支架置入后即刻，IRP 下降（平均[SD] 15.18±5.28 比 16.76±6.4mmHg，P=0.004），而蠕动活动保持不变。
正常肾脏的人体体内平均（SD）基线 IRP 为 14.19±4.39mmHg，肾积水和术前输尿管支架置入均会增加 IRP。肾盂内达到的平均（SD）蠕动峰值 IRP 值为 25.75±17.9mmHg，每 3-7 秒出现一次，并在支架置入后的早期保持不变。
