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Irrigation Mechanisms and Intrarenal Pressure in Flexible Ureteroscopy

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Flexible Ureteroscopy

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Abstract

Saline irrigation during flexible ureterorenoscopy (fURS) is necessary to maintain a clear vision during diagnostic and therapeutic procedures. Technological development has brought us different irrigation mechanisms, ranging from gravity irrigation to a variety of hand- and foot-controlled devices as well as automated pumps, the performance of which will be discussed in the clinical perspective.

As a result of scope manipulation and fluid irrigation, intrarenal pressure (IRP) unequivocally will increase during fURS. Data on IRP during experimental and clinical fURS is presented and discussed, including the role of ureteral access sheaths. Increases in IRP will often exceed thresholds for tubular (20–30 mmHg) and venous (30–50 mmHg) backflow, potentially resulting in septic complications. When IRP increases even further, forniceal rupture may occur, emerging into hemorrhagic complications. Additionally, IRP increments will produce strain in the pelvic/calyceal wall, thereby activating pacemaker cells that will initiate peristalsis, which may result in access-related problems. In this way, IRP variations represent the main determinant for adverse events in fURS. Preventive measures will be discussed, including potential role of pharmacological modulation of upper urinary tract dynamics.

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Abbreviations

fURS:

Flexible ureteroscopy

IRP:

Intrarenal pressure

PCNL:

Percutaneous nephrolithotomy

sURS:

Semirigid ureteroscopy

UAS:

Ureteral access sheath

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Authors and Affiliations

  1. Department of Urology, Aarhus University Hospital, Aarhus, Denmark

    Søren Kissow Lildal

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Søren Kissow Lildal

  3. Department of Urology, Vejle Hospital—A Part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark

    Palle Osther & Helene Jung

  4. Urological Research Center, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

    Palle Osther & Helene Jung

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  1. Søren Kissow Lildal
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Correspondence to Palle Osther .

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Editors and Affiliations

  1. The Department of Urology, The First Affiliated hospital of Guangzhou Medical University, Guangzhou, China

    Guohua Zeng

  2. Urology, Shyam Urosurgical Hospital, Ahmedabad, India

    Kandarp Parikh

  3. Department of Urology (UROLOGY), Biruni University, Medical School, Istanbul, Turkey

    Kemal Sarica

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Lildal, S.K., Osther, P., Jung, H. (2022). Irrigation Mechanisms and Intrarenal Pressure in Flexible Ureteroscopy. In: Zeng, G., Parikh, K., Sarica, K. (eds) Flexible Ureteroscopy. Springer, Singapore. https://doi.org/10.1007/978-981-19-2936-6_10

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  • DOI: https://doi.org/10.1007/978-981-19-2936-6_10

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