Human in vivo baseline intrarenal pressure, peristaltic activity and response to ureteric stenting

IF 3.7 2区医学 Q1 UROLOGY & NEPHROLOGY

BJU International Pub Date : 2024-08-06 DOI:10.1111/bju.16497

Stefanie M. Croghan, Eoghan M. Cunnane, Sorcha O’Meara, Connor V. Cunnane, James C. Forde, Rustom P. Manecksha, Michael T. Walsh, Kieran J. Breen, Barry B. McGuire, Fergal J. O’Brien, Niall F. Davis

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Abstract

Objectives

To assess human in vivo intrarenal pressure (IRP) and peristaltic activity at baseline and after ureteric stent placement, using a narrow calibre pressure guidewire placed retrogradely in the renal pelvis.

Patients and Methods

A prospective, multi-institutional study recruiting consenting patients undergoing ureteroscopy was designed with ethical approval. Prior to ureteroscopy, the urinary bladder was emptied and the COMET™ II pressure guidewire (Boston Scientific) was advanced retrogradely via the ureteric orifice to the renal pelvis. Baseline IRPs were recorded for 1–2 min. At procedure completion, following ureteric stent insertion, IRPs were recorded for another 1–2 min. Statistical analysis of mean baseline IRP, peristaltic waveforms and frequency of peristaltic contractions was performed, thereby analysing the influence of patient variables and ureteric stenting.

Results

A total of 100 patients were included. Baseline mean (±SD) IRP was 16.76 (6.4) mmHg in the renal pelvis, with maximum peristaltic IRP peaks reaching a mean (SD) of 25.75 (17.9) mmHg. Peristaltic activity generally occurred in a rhythmic, coordinated fashion, with a mean (SD) interval of 5.63 (3.08) s between peaks. On univariate analysis, higher baseline IRP was observed with male sex, preoperative hydronephrosis, and preoperative ureteric stenting. On linear regression, male sex was no longer statistically significant, whilst the latter two variables remained significant (P = 0.004; P < 0.001). The mean (SD) baseline IRP in the non-hydronephrotic, unstented cohort was 14.19 (4.39) mmHg. Age, α-blockers and calcium channel blockers did not significantly influence IRP, and no measured variables influenced peristaltic activity. Immediately after ureteric stent insertion, IRP decreased (mean [SD] 15.18 [5.28] vs 16.76 [6.4] mmHg, P = 0.004), whilst peristaltic activity was maintained.

Conclusions

Human in vivo mean (SD) baseline IRP is 14.19 (4.39) mmHg in normal kidneys and increases with both hydronephrosis and preoperative ureteric stenting. Mean (SD) peristaltic peak IRP values of 25.75 (17.9) mmHg are reached in the renal pelvis every 3–7 s and maintained in the early post-stent period.

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人体内肾内基线压力、蠕动活动和对输尿管支架的反应。

目的使用在肾盂逆行放置的窄口径压力导丝，评估基线和输尿管支架置入后的人体体内肾内压（IRP）和蠕动活动：我们设计了一项前瞻性、多机构研究，征集同意接受输尿管镜检查的患者，并获得了伦理批准。输尿管镜检查前，排空膀胱，经输尿管口将 COMET™ II 压力导丝（波士顿科学公司）逆行推进至肾盂。记录 1-2 分钟的基线 IRP。手术完成后，插入输尿管支架，再记录 1-2 分钟的 IRP。对平均基线 IRP、蠕动波形和蠕动收缩频率进行统计分析，从而分析患者变量和输尿管支架的影响：结果：共纳入 100 名患者。肾盂的基线 IRP 平均值（±SD）为 16.76 (6.4) mmHg，最大蠕动 IRP 峰值平均值（SD）为 25.75 (17.9) mmHg。蠕动活动通常以有节奏的协调方式进行，峰值之间的平均（标度）间隔为 5.63（3.08）秒。单变量分析显示，男性、术前肾积水和术前输尿管支架植入术会导致基线 IRP 增加。在线性回归分析中，男性性别不再具有统计学意义，而后两个变量仍然具有显著意义（P = 0.004；P 结论：男性性别、术前肾积水和术前输尿管支架置入的基线 IRP 值较高：正常肾脏的人体内平均（标度）基线 IRP 为 14.19 (4.39) mmHg，随着肾积水和术前输尿管支架植入的增加而增加。肾盂中的平均（标度）蠕动 IRP 峰值为 25.75 (17.9) mmHg，每 3-7 秒达到一次，并在支架术后早期保持不变。

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来源期刊

BJU International 医学-泌尿学与肾脏学

CiteScore

9.10

自引率

4.40%

发文量

262

审稿时长

1 months

期刊介绍： BJUI is one of the most highly respected medical journals in the world, with a truly international range of published papers and appeal. Every issue gives invaluable practical information in the form of original articles, reviews, comments, surgical education articles, and translational science articles in the field of urology. BJUI employs topical sections, and is in full colour, making it easier to browse or search for something specific.