Tokas Theodoros, Gauhar Vineet, Yuen Steffi Kar Kei, Somani Bhaskar Kumar
Department of Urology, Medical School, University General Hospital of Heraklion, University of Crete, Heraklion, Greece.
Training and Research in Urological Surgery and Technology (TRUST)-Group, Hall in Tirol, Austria.
Curr Opin Urol. 2025 Jul 1;35(4):390-398. doi: 10.1097/MOU.0000000000001270. Epub 2025 Feb 19.
Experimental evidence suggests that intrarenal temperatures (IRTs) and pressures (IRPs) during retrograde intrarenal surgery (RIRS) with laser lithotripsy are clinically significant. Suction devices aim to facilitate RIRS and improve procedure outcomes. We present an overview of new clinical studies regarding IRT, IRP, and suction developments.
High laser power, low irrigation, and restricted working space were directly correlated with increased IRTs. Increased irrigation flow rate and ureteral access sheath (UAS) maintained well tolerated IRTs. Baseline IRPs ranged from 16 to 17 mmHg. Intraoperative IRP monitoring maintained values below 22 mmHg. Hand-assisted pumps often increase IRPs above the safety threshold. Prolonged IRP increments were correlated to postoperative infections. Suction devices decreased operative time to less than 60 min and improved stone-free rates (SFRs) at 1 day to more than 80 and at 30 days to more than 90%.
Despite the limited clinical evidence, IRTs during RIRS correlate directly with laser power and reversely correlate with irrigation flow rate and UAS use. Intraoperative IRP monitoring prevents hazardous increments. Manual pump irrigation causes extremely high IRPs. There is a possible relation between prolonged IRP increments and infectious complication development. Using suction UAS or flexible and navigable sheaths (FANS) improves operative times and SFRs, while more studies regarding direct in-scope suction (DISS) efficiency and safety are needed.
实验证据表明，在采用激光碎石术的逆行性肾内手术（RIRS）过程中，肾内温度（IRT）和压力（IRP）具有临床意义。抽吸装置旨在促进RIRS并改善手术效果。我们概述了有关IRT、IRP和抽吸技术发展的新临床研究。
高激光功率、低灌注量和有限的工作空间与IRT升高直接相关。增加灌注流速和输尿管通路鞘（UAS）可使IRT保持在可耐受水平。基线IRP范围为16至17 mmHg。术中IRP监测可使值保持在22 mmHg以下。手动辅助泵常常会使IRP升高至安全阈值以上。IRP持续升高与术后感染相关。抽吸装置可将手术时间缩短至60分钟以内，并使术后1天的结石清除率（SFR）提高至80%以上，术后30天提高至90%以上。
尽管临床证据有限，但RIRS期间的IRT与激光功率直接相关，与灌注流速和UAS的使用呈负相关。术中IRP监测可防止危险的升高。手动泵灌注会导致极高的IRP。IRP持续升高与感染性并发症的发生之间可能存在关联。使用抽吸式UAS或柔性可导航鞘（FANS）可改善手术时间和SFR，不过仍需要更多关于直视下抽吸（DISS）效率和安全性的研究。
