负压输尿管鞘在钬激光碎石术中预防“输尿管热损伤”的作用

Impact of negative-pressure ureteral access sheath on preventing "boiled ureter" during holmium laser lithotripsy.

作者信息

Song Baiyang, Du Haojie, Cheng Yue, Xie Guohai, Hu Jiasheng, Yu Chengling, Zheng Xiaodong, Yan Zejun, Fang Li

机构信息

Department of Urology, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, Zhejiang, People's Republic of China.

Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences, Ningbo, 315201, Zhejiang, People's Republic of China.

出版信息

World J Urol. 2025 Jun 12;43(1):371. doi: 10.1007/s00345-025-05743-w.

DOI:10.1007/s00345-025-05743-w

PMID:40504252

Abstract

PURPOSE

To evaluate the impact of negative-pressure ureteral access sheath (NP-UAS) on thermal effects during holmium laser lithotripsy.

MATERIALS AND METHODS

A 3D-printed urinary model was used. A ureteroscope, traditional UAS (T-UAS) or NP-UAS, and a 200 µm hollium laser fiber were introduced into the model's proximal ureter, with the fiber activated for 90 s. Lithotripsy temperature (LT), irrigation flow rate (IFR), and intrarenal pressure (IRP) were measured during flexible ureteroscopic lithotripsy (fURL) and ureteroscopic lithotripsy (URL) using T-UAS or NP-UAS under varying irrigation pressures (IP) and laser powers.

RESULTS

During fURL at 10 kPa IP, the maximum LT exceeded 43 °C at laser powers of 20W, 30W, and 50W in the T-UAS group, while the NP-UAS group maintained LT < 43 °C. NP-UAS demonstrated significantly greater efficacy in controlling IFR and IRP compared to T-UAS (62.33 ± 2.35 vs. 24.01 ± 0.55 mL/min and 9.13 ± 0.21 vs. 1530.08 ± 112.43 Pa, respectively; p < 0.0001). At 20 kPa IP, only the T-UAS group exceeded a maximum LT of 43 °C at 50W, whereas the NP-UAS group remained below 43 °C. IFR and IRP measures for NP-UAS and T-UAS were 84.24 ± 1.74 mL/min vs. 46.31 ± 0.37 mL/min and 9.89 ± 0.15 Pa vs. 1646.61 ± 38.19 Pa, respectively (p < 0.0001). During URL, all groups maintained LT < 43 °C. At 10 kPa IP, IFR and IRP for NP-UAS and T-UAS were 78.28 ± 1.01 mL/min vs. 44.99 ± 1.09 mL/min and 4752.40 ± 267.72 Pa vs. 7769.63 ± 608.76 Pa, respectively (p < 0.0001). At 20 kPa IP, NP-UAS showed superior IFR (91.33 ± 4.46 mL/min vs. 78.48 ± 0.96 mL/min, p < 0.0001), with IRP exceeding measurement limits in both groups.

CONCLUSION

Increasing IFR reduces LT but elevates IRP. NP-UAS effectively maintains LT below critical levels while keeping IRP safe during both fURL and URL.

摘要

目的

评估负压输尿管通路鞘（NP-UAS）对钬激光碎石术期间热效应的影响。

材料与方法

使用3D打印的泌尿系统模型。将输尿管镜、传统输尿管通路鞘（T-UAS）或NP-UAS以及一根200μm的钬激光光纤插入模型的近端输尿管，光纤激活90秒。在不同的冲洗压力（IP）和激光功率下，使用T-UAS或NP-UAS进行软性输尿管镜碎石术（fURL）和输尿管镜碎石术（URL）时，测量碎石温度（LT）、冲洗流速（IFR）和肾内压（IRP）。

结果

在IP为10kPa的fURL期间，T-UAS组在激光功率为20W、30W和50W时，最大LT超过43°C，而NP-UAS组的LT保持<43°C。与T-UAS相比，NP-UAS在控制IFR和IRP方面表现出显著更高的效果（分别为62.33±2.35 vs. 24.01±0.55 mL/min和9.13±0.21 vs. 1530.08±112.43 Pa；p<0.0001）。在IP为20kPa时，只有T-UAS组在50W时超过了43°C的最大LT，而NP-UAS组保持在43°C以下。NP-UAS和T-UAS的IFR和IRP测量值分别为84.24±1.74 mL/min vs. 46.31±0.37 mL/min和9.89±0.15 Pa vs. 1646.61±38.19 Pa（p<0.0001）。在URL期间，所有组的LT均保持<43°C。在IP为10kPa时，NP-UAS和T-UAS的IFR和IRP分别为78.28±1.01 mL/min vs. 44.99±1.09 mL/min和4752.40±267.72 Pa vs. 7769.63±608.76 Pa（p<0.0001）。在IP为20kPa时，NP-UAS显示出更高的IFR（91.33±4.46 mL/min vs. 78.48±0.96 mL/min，p<0.0001），两组的IRP均超过测量极限。