Liu Xiaohui, Han Zhenyuan, Wang Baosen, Zhou Yajie, Luo Xiaoqing, Wang Dong
Department of Urology, The People's Hospital of Huantai, Zibo City, Shandong, China.
Nursing Department, The People's Hospital of Huantai, Zibo City, Shandong, China.
Int J Surg. 2025 Jul 1;111(7):4234-4238. doi: 10.1097/JS9.0000000000002499. Epub 2025 May 20.
Intrarenal pressure (IRP) is challenging to measure during retrograde intrarenal surgery (RIRS). Distal end-mounted pressure sensors in flexible ureteroscope (fURS) or ureteral access sheath (UAS) offer real-time pressure measurement, which may address this issue. Pyelorenal reflux occurs in the renal calyces, particularly at the fornices. No study has yet investigated whether there is a pressure differential between the renal pelvis and the calyces. This research aims to examine this topic using the porcine kidney model developed at our institution.
Twelve adult porcine kidneys were used. Three pressure measuring catheters were inserted into upper, middle, and lower calyces. IRPs were studied using either conventional UAS (cUAS) or vacuum-assisted UAS (vaUAS) with a fourth measure monitor catheter inside and level with the tip of UAS and a 7.5F fURS. Incremental rate of irrigation was delivered through the fURS and IRPs were measured and recorded.
In cUAS, there were statistically significant reductions in pressure, ranging from small to moderate, observed in both the upper and lower calyces compared to the renal pelvis. These pressure differences disappeared when irrigation reached >90 c.c./minute. In vaUAS with vent closed: The IRP remained negligible even with irrigation up to 140 c.c./minute. Interestingly, there were very small but significantly less pressures in all three calyces as compared to the real pelvises when irrigation rate was ≧90 c.c./minute. There were no differences in pressure with irrigation below 90 c.c./minute.
Real-time IRP measurement during RIRS with cUAS can provide valuable clinical insights. Porcine kidney studies show slightly less pressure in the calyces than the renal pelvis. vaUAS reduces high IRP and pressure gradients, potentially making real-time IRP measurement unnecessary.
在逆行性肾内手术（RIRS）期间测量肾内压（IRP）具有挑战性。柔性输尿管镜（fURS）或输尿管通路鞘（UAS）中的远端端部安装压力传感器可提供实时压力测量，这可能解决此问题。肾盂肾反流发生在肾盏，特别是在穹窿处。尚无研究调查肾盂和肾盏之间是否存在压力差。本研究旨在使用我们机构开发的猪肾模型来研究这一主题。
使用12个成年猪肾。将三根压力测量导管插入上、中、下肾盏。使用传统UAS（cUAS）或真空辅助UAS（vaUAS），在其内部并与UAS尖端齐平放置第四根测量监测导管以及一根7.5F fURS来研究IRP。通过fURS以递增的冲洗速率进行冲洗，并测量和记录IRP。
在cUAS中，与肾盂相比，在上、下肾盏中观察到压力有统计学意义的降低，范围从小到中等。当冲洗量达到>90毫升/分钟时，这些压力差消失。在vaUAS且通气口关闭的情况下：即使冲洗量高达140毫升/分钟，IRP仍然可以忽略不计。有趣的是，当冲洗速率≥90毫升/分钟时，与实际肾盂相比，所有三个肾盏中的压力都非常小但显著更低。冲洗量低于90毫升/分钟时压力没有差异。
在RIRS期间使用cUAS进行实时IRP测量可提供有价值的临床见解。猪肾研究表明肾盏中的压力略低于肾盂。vaUAS降低了高IRP和压力梯度，可能使实时IRP测量变得不必要。
