Renal pelvis pressure and flowrate with a multi-channel ureteroscope: invoking the concept of outflow resistance.

IF 2 2区 医学 Q2 UROLOGY & NEPHROLOGY
Anthony F Bonzagni, Timothy L Hall, Khurshid R Ghani, William W Roberts
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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.

多通道输尿管镜下肾盂压力和流速:援引流出阻力的概念。
在输尿管镜检查(URS)中了解肾盂压力(PRP)已变得越来越重要。高灌溉率,理想的保持可视化和限制热剂量,可以增加PRP。使用具有专用引流通道的多通道输尿管镜(m-输尿管镜)是一种可以同时促进低PRP和高流量的策略。我们试图通过m-输尿管镜和单通道输尿管镜(s-输尿管镜)确定在一系列不同流出阻力情况下PRP和流速之间的关系。将输尿管镜置于经验证的硅胶肾输尿管模型的骨盆内。试验在灌溉压力(50-150 cmH20)下进行,并使用不同长度和直径的导管模拟五种不同的流出阻力情况。PRP通过放置在肾盂内的光纤压力传感器测量。通过测量60 s内排水液的质量来确定流量。在相同流速下,m输尿管镜的PRP低于s输尿管镜(即在高流出阻力情况下,15 ml/min灌洗分别为34 cmH20和82 cmH20)。当施加相同的冲洗压力时,m输尿管镜的流速高于s输尿管镜(即在高流出阻力情况下,分别为28 ml/min和14 ml/min,冲洗压力为150 cmH20)。m输尿管镜改善了压力-血流动力学,赋予重要的临床益处。更重要的是,这种在阻力值相关的压力-流量关系背景下构建输尿管镜的方法允许在确定性系统内对输尿管镜进行量化,这可用于简化未来的设备开发和技术创新。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Urolithiasis
Urolithiasis UROLOGY & NEPHROLOGY-
CiteScore
4.50
自引率
6.50%
发文量
74
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.
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