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

摘要

PurposeTo 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.MethodsA 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.ResultsIRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8-199.35, 3-40.8, 10-45 and 15.37-41.21cm H2O, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30cm H2O at an irrigation pressure (IP) of100cm H2O but could increase to40cm H2O at an IP of 200cm H2O. By utilizing the minimally invasive PCNL system, IRPs remain low at 20cm 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 50cm H2O.ConclusionsIncreased 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.