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01-01-2019 | Invited Review

Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures

Authors: Theodoros Tokas, Andreas Skolarikos, Thomas R. W. Herrmann, Udo Nagele, Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

Published in: World Journal of Urology | Issue 1/2019

Abstract

Purpose

To perform a review on the latest evidence related to intrarenal pressures (IRPs) generated during upper-tract endourology, and present different tools to maintain decreased values, to decrease complication rates.

Methods

A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal-pelvic pressure.

Results

IRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8–199.35, 3–40.8, 10–45 and 15.37–41.21 cm H₂O, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30 cm H₂O at an irrigation pressure (IP) of ≤ 100 cm H₂O but could increase to > 40 cm H₂O at an IP of 200 cm H₂O. By utilizing the minimally invasive PCNL system, IRPs remain low at 20 cm H₂O even at high IPs. Utilizing endoluminal isoproterenol during RIRS, could reduce IRP increases with a rate of 27–107%, and maintain low IRPs values, usually below 50 cm H₂O.

Conclusions

Increased IRP values have been reported during RIRS and UASs constitute the most efficient tool for decreasing them. IRPs during mini-PCNL can be decreased utilizing the vacuum-cleaner and purging effects but might remain uncontrolled during micro- and ultra-mini PCNL. Intraluminal pharmacological treatment could play a role in IRP decrease, with isoproterenol being the most studied agent.

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Title: Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures
Authors: Theodoros Tokas
Andreas Skolarikos
Thomas R. W. Herrmann
Udo Nagele
Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
Publication date: 01-01-2019
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 1/2019
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-018-2379-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Pressure matters 2: intrarenal pressure ranges during upper-tract endourological procedures

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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