Anthony F Bonzagni, Timothy L Hall, Khurshid R Ghani, William W Roberts
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引用次数: 0
Abstract
Understanding renal pelvis pressure (PRP) during ureteroscopy (URS) has become increasingly important. High irrigation rates, desirable to maintain visualization and limit thermal dose, can increase PRP. Use of a multi-channel ureteroscope (m-ureteroscope) with a dedicated drainage channel is one strategy that may facilitate simultaneous low PRP and high flowrate. We sought to define the relationship between PRP and flowrate across a range of different outflow resistance scenarios with an m-ureteroscope versus a single-channel ureteroscope (s-ureteroscope). The m- or s-ureteroscope was placed into the pelvis of a validated silicone kidney-ureter model. Trials were conducted at irrigation pressures (50-150 cmH20) and five different outflow resistance scenarios simulated with catheters of different lengths and diameters. PRP was measured with a fiber optic pressure sensor positioned in the renal pelvis. Flowrate was determined by measuring the mass of drainage fluid over 60 s. PRP was lower with the m-ureteroscope than the s-ureteroscope when equivalent flowrates were delivered (i.e. 34 vs. 82 cmH20 respectively with 15 ml/min irrigation in a high outflow resistance scenario). Flowrate was higher with the m-ureteroscope than the s-ureteroscope when equivalent irrigation pressures were applied (i.e. 28 vs. 14 ml/min respectively with irrigation pressure 150 cmH20 in a high outflow resistance scenario). The m-ureteroscope has improved pressure-flow dynamics imparting important clinical benefits. More importantly, this approach to framing ureteroscopy in the context of pressure-flow relationships related by resistance values allows quantification of ureteroscopy within a deterministic system, which can be used to streamline future device development and technological innovation.
期刊介绍:
Official Journal of the International Urolithiasis Society
The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field.
Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.