Glienke Leilane, Hall Timothy L, Roberts William W
Department of Urology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-5330, USA.
Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
World J Urol. 2025 May 21;43(1):319. doi: 10.1007/s00345-025-05708-z.
Suction has recently been introduced into the ureteroscopic armamentarium to improve stone fragment and debris clearance. However, the benefits of suction appear to be limited by current irrigation systems. This study aimed to measure the time to clear sand ureteroscopically from a transparent silicone kidney-ureter model at different flowrates and compare with results with conventional pressurized irrigation and intermittent suction.
A LithoVue™ Elite ureteroscope was inserted through a Clear Petra 11/13 Fr 46 cm or 12/14 Fr 50 cm FANS device into a transparent silicone kidney model. Irrigation was delivered from a peristaltic pump at rates of 18-90 ml/min with pump assisted outflow or from a pressurized source with suction assisted outflow. Intrarenal pressure (IRP) was maintained between 30-40 cmHO. Trials were conducted to measure the time required to completely aspirate 0.5 g of sand from the mid and upper calyces.
Sand was cleared more quickly from the kidney model as flowrate increased up to ~ 70-80 ml/min. Use of continuous flowrate was more efficient at clearing sand than variable flowrate produced by bursts of intermittent suction.
Flowrate is a primary variable affecting efficiency of sand clearance in in vitro studies. Current clinical methods that utilize intermittent suction during ureteroscopy are likely less efficient than configurations that provide continuous flowrates. Incorporation of IRP feedback into irrigation systems may facilitate high flowrate while maintaining stable low IRP, thereby enhancing efficiency and safety of ureteroscopy.
最近输尿管镜设备中引入了抽吸技术以改善结石碎片和碎屑的清除。然而，抽吸的益处似乎受到当前冲洗系统的限制。本研究旨在测量在不同流速下通过输尿管镜从透明硅胶肾输尿管模型中清除沙子的时间，并与传统加压冲洗和间歇性抽吸的结果进行比较。
将LithoVue™ Elite输尿管镜通过Clear Petra 11/13 Fr 46 cm或12/14 Fr 50 cm FANS装置插入透明硅胶肾模型中。通过蠕动泵以18 - 90 ml/min的流速进行冲洗并辅助流出，或通过加压源并辅助抽吸流出。肾内压（IRP）维持在30 - 40 cmHO之间。进行试验以测量从中部和上部肾盏完全吸出0.5 g沙子所需的时间。
随着流速增加至约70 - 80 ml/min，沙子从肾模型中清除得更快。使用连续流速清除沙子比间歇性抽吸脉冲产生的可变流速更有效。
在体外研究中，流速是影响沙子清除效率的主要变量。当前输尿管镜检查期间使用间歇性抽吸的临床方法可能不如提供连续流速的配置有效。将IRP反馈纳入冲洗系统可能有助于实现高流速，同时保持稳定的低IRP，从而提高输尿管镜检查的效率和安全性。
