1. Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure.
- Author
-
Caballero-Romeu JP, Galán-Llopis JA, Soria F, Morcillo-Martín E, Caballero-Pérez P, Garcia A, De La Cruz-Conty JE, and Romero-Maroto J
- Subjects
- Animals, Disease Models, Animal, Female, Hemodynamics, Intra-Abdominal Hypertension etiology, Intra-Abdominal Hypertension prevention & control, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures instrumentation, Minimally Invasive Surgical Procedures methods, Models, Anatomic, Regional Blood Flow, Swine, Treatment Outcome, Kidney blood supply, Kidney diagnostic imaging, Kidney physiopathology, Miniaturization methods, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications prevention & control, Ureteroscopy adverse effects, Ureteroscopy instrumentation, Ureteroscopy methods, Urolithiasis surgery
- Abstract
Purpose: Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS., Methods: A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured., Results: The range of average pressures was 5.08-14.1 mmHg in the m-URS group and 6.08-20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001)., Conclusions: m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
- Published
- 2018
- Full Text
- View/download PDF