Journal of endourology最新文献

{"title":"Single-Port and Multi-Port Robotic Donor Nephrectomy.","authors":"Chih Peng Chin, Micah Levy, Modassar Awan, Michael Palese","doi":"10.1089/end.2024.0421","DOIUrl":"https://doi.org/10.1089/end.2024.0421","url":null,"abstract":"<p><p>Robotic donor nephrectomy (RDN) has been shown to be a safe and effective method for living donor nephrectomy. RDN can utilize both a multi-port (MP) and a single-port (SP) approach, which share many similarities but differ in certain aspects of the preoperative and intraoperative approach. These differences and the findings of studies reporting clinical outcomes of both the MP and SP approaches are discussed in the following video and written article. In this article, we describe the indications, preoperative preparations, and postoperative care plans for RDN at our institution as well as some of the major differences in the equipment, patient positioning, and port placements for the MP <i>vs</i> SP approaches. We then detail the 12-step surgical technique for both the MP and SP, indicating major differences in how the surgical approach can impact intraoperative measures. Finally, we summarize our recent findings on the clinical success of the MP and SP approaches as compared with laparoscopic approaches and between the MP and SP techniques. Together, our clinical and research experiences have shown that both the MP and SP are safe, feasible, and effective options for living donor nephrectomy. When compared with the laparoscopic technique and when comparing the MP with the SP approaches, they both offer comparable graft outcomes. From our clinical experience, certain aspects of the SP approach may offer advantages during specific steps of the procedure. Future randomized prospective clinical trials are necessary to confirm the findings of our clinical and research experiences and to continue to identify possible benefits or drawbacks of the SP and MP RDN.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S66-S71"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Deep Learning Reconstruction Improve Ureteral Stone Detection and Subjective Image Quality in the CT Images of Patients with Metal Hardware?","authors":"Ruben Crew, Jason Smith, Mohammad Kassir, Ala'a Farkouh, Kai Wen Cheng, Bertha Escobar-Poni, Jun Ho Chung, Uy Lae Kim, Jammie-Lyn Quines, Grant Sajdak, Katya Hanessian, Sikai Song, Akin S Amasyali, Zhamshid Okhunov, Udochukwo Oyoyo, D Daniel Baldwin, Kerby Oberg, D Duane Baldwin","doi":"10.1089/end.2024.0666","DOIUrl":"10.1089/end.2024.0666","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Diagnosing ureteral stones with low-dose CT in patients with metal hardware can be challenging because of image noise. The purpose of this study was to compare ureteral stone detection and image quality of low-dose and conventional CT scans with and without deep learning reconstruction (DLR) and metal artifact reduction (MAR) in the presence of metal hip prostheses. <b><i>Methods:</i></b> Ten urinary system combinations with 4 to 6 mm ureteral stones were implanted into a cadaver with bilateral hip prostheses. Each set was scanned under two different radiation doses (conventional dose [CD] = 115 mAs and ultra-low dose [ULD] = 6.0 mAs). Two scans were obtained for each dose as follows: one with and another without DLR and MAR. Two blinded radiologists ranked each image in terms of artifact, image noise, image sharpness, overall quality, and diagnostic confidence. Stone detection accuracy at each setting was calculated. <b><i>Results:</i></b> ULD with DLR and MAR improved subjective image quality in all five domains (<i>p</i> < 0.05) compared with ULD. In addition, the subjective image quality for ULD with DLR and MAR was greater than the subjective image quality for CD in all five domains (<i>p</i> < 0.05). Stone detection accuracy of ULD improved with the application of DLR and MAR (<i>p</i> < 0.05). Stone detection accuracy of ULD with DLR and MAR was similar to CD (<i>p</i> > 0.25). <b><i>Conclusions:</i></b> DLR with MAR may allow the application of low-dose CT protocols in patients with hip prostheses. Application of DLR and MAR to ULD provided a stone detection accuracy comparable with CD, reduced radiation exposure by 94.8%, and improved subjective image quality.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"306-313"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Renal Pelvis Urine Density and the Risk of Infectious Complications after Retrograde Intrarenal Surgery.","authors":"Ufuk Caglar, Caglar Dizdaroglu, Resit Yusuf, Ufuk Can Aksu, Ali Ayranci, Omer Sarilar, Faruk Ozgor","doi":"10.1089/end.2024.0578","DOIUrl":"10.1089/end.2024.0578","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Renal pelvis urine density (RPUD), as measured by computed tomography (CT), may serve as an effective predictor for pyonephrosis. Our objective was to evaluate the correlation between the likelihood of developing infectious complications post-retrograde intrarenal surgery (RIRS) and RPUD measurements obtained from preoperative CT scans. <b><i>Materials and Methods:</i></b> We retrospectively reviewed data from patients who underwent RIRS for kidney stone treatment at a tertiary care facility between June 2017 and June 2024, using the hospital's database. The patients were divided into two groups based on the development of postoperative infective complications. The groups were compared in terms of preoperative (demographic data, stone characteristic, and RPUD) and operation data. RPUD was measured by creating an ellipse much as possible area encompassing the renal pelvis on the treated side area encompassing the renal pelvis on the treated side, and the average Hounsfield unit (HU) value was recorded. <b><i>Results:</i></b> Postoperative infection developed in 31 of 588 patients (5.3%). The median RPUD value was 15 in the infective group and 8 in the noninfective group, with a statistically significant difference between the groups (<i>p</i> = 0.001). Body mass index, stone burden, stone density, and RPUD were associated with postoperative infection in the multivariate analysis (<i>p</i> = 0.001, <i>p</i> = 0.008, <i>p</i> = 0.007, and <i>p</i> = 0.001, respectively). Each unit increase in RPUD increased the risk of postoperative infection 1.107-fold. The receiver operating characteristic (ROC) analysis demonstrated a significant relationship between RPUD value and the risk of postoperative infection, with an area under the curve of 0.742 (<i>p</i> = 0.001). When the RPUD cut-off value was accepted as 14, sensitivity was 0.613 and specificity was 0.779. <b><i>Conclusion:</i></b> This study showed a significant association between HU values in RPUD and the risk of infectious complications following RIRS. This finding suggests that incorporating urine HU values from CT images into preoperative risk assessment could be crucial for infection prevention and management.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"231-236"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of Patient-Specific Nomogram to Assist in Clinical Decision-Making for Single Port Versus Multi-Port Robotic Partial Nephrectomy: A Report from the Single Port Advanced Robotic Consortium.","authors":"Nicolas A Soputro, Kennedy E Okhawere, Roxana Ramos-Carpinteyro, Ruben Sauer Calvo, Yuzhi Wang, Celeste Manfredi, Elizabeth Snajdar, Michael Raver, Indu Saini, Jaya S Chavali, Carter D Mikesell, Adriana M Pedraza, Mutahar Ahmed, Michael D Stifelman, Craig Rogers, Adam Lorentz, Riccardo Autorino, Bertram Yuh, Ryan J Nelson, Simone Crivellaro, Ketan K Badani, Jihad Kaouk","doi":"10.1089/end.2024.0547","DOIUrl":"10.1089/end.2024.0547","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To develop a patient-specific algorithm to better guide clinical decision-making when considering between single port (SP) and multi-port (MP) robotic partial nephrectomy (RPN). <b><i>Materials and Methods:</i></b> A retrospective review was performed on the institutional review board-approved, prospectively maintained multi-institutional database of the Single Port Advanced Research Consortium to identify all consecutive patients who underwent SP and MP-RPN between 2019 and 2023. Baseline clinicodemographic variables were used to identify the significant predictors of SP-RPN. The significant variables were used to construct a nomogram to predict the likelihood of SP vs MP-RPN. <b><i>Results:</i></b> Of the 1021 patients included in our analysis, 189 (18.5%) and 832 (81.5%) underwent SP and MP-RPN, respectively. Statistically significant predictors of SP-RPN included a lower comorbidity profile, a significant abdominal surgical history as characterized by a higher Hostile Abdomen Index, as well as tumors of lower complexity. The nomogram generated using the aforementioned variables demonstrated a reasonable performance with an area under the curve of 0.79. An optimal cutoff point was determined, with likelihood ratios above 0.12 indicating a preference for SP-RPN. Of note, all SP-RPN cases that scored above the 0.12 cutoff exhibited improved perioperative outcomes, including shorter ischemia time and less intraoperative blood loss. <b><i>Conclusions:</i></b> In this study, we have devised a novel patient selection nomogram aimed at enhancing clinical decision-making within the expanding repertoire of RPN approaches. The findings highlighted in this study offer valuable guidance to facilitate appropriate patient selection and thereby ensuring favorable perioperative outcomes associated with RPN procedures.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"252-260"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retzius-Sparing Robot-Assisted Radical Prostatectomy.","authors":"Santhosh Nagasubramanian, Jeffrey J Leow, Prasanna Sooriakumaran","doi":"10.1089/end.2024.0616","DOIUrl":"https://doi.org/10.1089/end.2024.0616","url":null,"abstract":"<p><p>Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) is a technically challenging procedure, which can confer benefits of early return to urinary continence. This article describes the indications, relative contraindications, preoperative preparation, surgical steps, and postoperative care of patients who undergo RS-RARP. In addition, we highlight several scenarios where RS-RARP can be attempted, such as anterior tumors, large median lobes, previous bladder outlet operation, pelvic lymph node dissection, previous inguinal hernia mesh procedure, salvage operation, and renal transplant recipients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S27-S34"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Port <i>vs</i> Multiport Robotic Surgery in Urologic Oncology: A Narrative Review.","authors":"Mark C Xu, Ashok K Hemal","doi":"10.1089/end.2024.0528","DOIUrl":"10.1089/end.2024.0528","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Robotic surgery has improved the oncologic and functional outcomes of many urologic oncology procedures by optimizing visualization and instrument maneuverability. Since its FDA approval in 2018, the daVinci single-port (SP) platform has become increasingly utilized in urologic oncology, with its theoretical advantages over the standard multiport (MP) platform including improved cosmesis, reduced pain, and shorter hospitalization. Given this platform's relative novelty, comparisons between SP and MP robotic surgeries in urologic oncology tend to be small, non-randomized studies performed at centers of excellence. We review the existing literature comparing oncologic and functional outcomes between SP and MP surgeries to treat prostate, kidney, and bladder cancer. <b><i>Methods:</i></b> A literature review was performed in PubMed for studies comparing SP and MP prostatectomies, nephrectomies, and cystectomies from 2018 to 2024. The search was limited to English studies. Studies evaluating prostatectomy, nephrectomy, and cystectomy for nononcologic indications were excluded. <b><i>Results:</i></b> No difference in margin status or recurrence was definitively demonstrated between SP and MP radical prostatectomy, partial nephrectomy, or radical cystectomy. No clear difference in operative time, blood loss, or complication rates between SP and MP surgery was found. SP surgery may improve length of stay, pain, and satisfaction with incisions compared with MP surgery, though these differences were not robustly demonstrated across all studies. Key functional outcomes, such as change in kidney function in partial nephrectomy, and erectile/urinary function in radical prostatectomy, were similar between the SP and MP platforms. <b><i>Conclusion:</i></b> Based on current evidence from experienced surgeons at centers of excellence, the daVinci SP platform allows urologists to perform common oncologic procedures safely and effectively. Currently, no data definitively establishes improved oncologic or functional outcomes for SP surgery over MP surgery, though improved hospital stay and cosmesis are identified as theoretical benefits of an SP procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"271-284"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aquablation Compared with Simple Prostatectomy for Prostate Volumes >80 Grams.","authors":"David Gangwish, Minhaj Jabeer, Aidan Kennedy, Joshua Kuperus, Paul Horning, Greg Palmateer, Bernadette M M Zwaans, Jason Hafron, Kenneth M Peters","doi":"10.1089/end.2024.0583","DOIUrl":"10.1089/end.2024.0583","url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Aquablation (Aqua) is a novel technique for treating benign prostatic hyperplasia and lower urinary tract symptoms. This study compares Aqua to simple prostatectomy (SP), analyzing functional urinary outcomes, adverse events (AE), and retreatment rates. <b><i>Methods:</i></b> A single-institution retrospective chart review was conducted for men undergoing open/robotic SP or Aqua from 2017 to 2023 for prostates >80 mL. Data collected included blood transfusions, AE, retreatment rates, postoperative medication use, and International Prostate Symptom Score (IPSS) with quality-of-life (QOL) indicator. To address differences in baseline characteristics, including prostate size, we applied inverse probability of treatment weighting (IPTW). Statistical analyses were performed using R 4.4.0. Results are presented as IPTW-adjusted comparing SP to Aqua using Fischer's exact test and analysis of variance reported as beta (B) for continuous variables and odds ratios (OR) for categorical variables with 95% confidence intervals (CI). <b><i>Results:</i></b> In total, 172 patients were studied: 111 Aqua and 61 SP. Groups were well-matched for body mass index (Aqua 28.77 <i>vs</i> SP 28). Aqua patients were older (73.04 <i>vs</i> 68.89), had smaller prostates (135.46 <i>vs</i> 186.53 mL), and lower preoperative urinary retention (21.8% <i>vs</i> 47.5%). Baseline characteristics between groups were adjusted using IPTW. SP outperformed Aqua in 1-year IPSS scores (<i>B</i> = -3.4, CI: -5.7, -1.1, <i>p</i> = 0.005), whereas QOL was comparable (<i>B</i> = -0.46, CI: -1.3, 0.33, <i>p</i> = 0.2). SP patients continued alpha-blockers less often postoperatively (<i>B</i> = -0.27, CI: -0.39, -0.41, <i>p</i> = 0.001). SP showed higher blood transfusion rates (OR = 4.22, CI: 1.64, 13.2, p = 0.006), longer hospital stays (<i>B</i> = 1.7, CI: 1.0, 2.4, <i>p</i> < 0.001), and longer operating times (<i>B</i> = 119, CI: 101, 135, <i>p</i> < 0.001). SP had lower retreatment rates (OR = 0.46, CI: 0.23, 0.87, <i>p</i> = 0.019). AE were not significantly different (<i>p</i> = 0.8). <b><i>Conclusions:</i></b> Aqua outperformed SP for blood transfusions, hospital stay, and operative time. SP outperformed Aqua for retreatment rates, IPSS scores at 1-year follow-up, and reliance on alpha-blockers.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"298-305"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transperineal MR Fusion Laser Ablation of Prostate Cancer in Office Setting: 1 Year Efficacy and Safety Outcomes in Intermediate-Risk Patients.","authors":"Giuseppe Maiolino, Alberto Lopez-Prieto, Gloria Egui-Benatuil, Ariel M Kaufman, Edward L Gheiler, Fernando J Bianco","doi":"10.1089/end.2024.0776","DOIUrl":"10.1089/end.2024.0776","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Focal therapy (FT) is an emerging option for intermediate-risk prostate cancer (IR-PCa). Transperineal MRI fusion laser ablation of PCa (TPFLA) is a novel FT technique with limited data reported. We conducted a phase I clinical trial evaluating the safety, feasibility, and 1-year oncologic results for patients with IR-PCa treated with TPFLA in an office setting. <b><i>Materials and Methods:</i></b> NCT05241236 aimed to evaluate TPFLA for the International Society of Urological Pathology-grade 2 (ISUP-2) tumors. All procedures were performed in the office using MR/US fusion imaging. The diode interstitial laser system fibers were applied through the perineum using local anesthesia. The primary outcome was safety and tolerability. Pain scores were recorded using analog scales. Thirty-day adverse events and 1-year prostate biopsy oncologic outcomes were noted. Functional outcomes at 3 months and 1 year were compared with baseline as well. <b><i>Results:</i></b> Thirty patients accrued had TPFLA safely in the office with no complications. TPFLA median pain score was 1. At 30 days, one man required a transurethral resection of the prostate (TURP). There were no imaging demonstrable cancers at 3 months and a significant improvement in urinary function (<i>p</i> = 0.001) was noted and sustained for the year. No patient experienced urinary incontinence. No changes in sexual function were observed (<i>p</i> = 0.7). At 1 year, 25/30 (83%) had no clinically significant cancer. However, 14 had PCa, in 5 (17%) solely in treated areas, all ISUP-1. Seven had PCa outside the treated areas. Two had infield and outfield recurrences, both were ISUP 2. At study closure, 16 patients were free from PCa, 3 were on active surveillance, 9 were treated focally with cryoablation, and 2 were converted to radical surgical procedure. <b><i>Conclusions:</i></b> TPFLA appears to be a safe and an effective focal therapy for IR-PCa, offering a potential alternative to more radical treatments with a minimal periprocedural impact. Longer follow-up and larger studies are needed to confirm these results.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"S13-S20"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RE: Does Blacklight Illumination Improve Speed and Accuracy of Foot Pedal Activation in the Low Light Operating Room?","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1089/end.2024.0631","DOIUrl":"10.1089/end.2024.0631","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"e329-e330"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Mini-Percutaneous Nephrolithotomy Cause Increased Intrarenal Pressure During Percutaneous Nephrolithotomy and is This Mitigated by a Suctioning Sheath? A Randomized Control Trial.","authors":"Raymond Khargi, Juan S Serna, Kavita Gupta, Alan J Yaghoubian, Christopher Connors, Kasmira R Gupta, Anna Ricapito, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0390","DOIUrl":"10.1089/end.2024.0390","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Intrarenal pressure (IRP) generated during percutaneous nephrolithotomy (PCNL) may have the potential to cause renal damage and/or sepsis. It has been suggested that mini-PCNL (mPCNL) can further increase IRP but that a suctioning sheath may mitigate this elevation. We sought to measure IRP throughout the PCNL process, randomizing patients getting mPCNL to receiving two different mPCNL sheaths, one suctioning and the other nonsuctioning, and then comparing them with patients undergoing standard PCNL (sPCNL) using a 24F sheath. <b><i>Patients and Methods:</i></b> Twenty patients meeting the eligibility criteria for mPCNL were randomized into two groups: suctioning mPCNL (s-mPCNL) with a single-step dilator and continuous suction sheath (ClearPetra™, 18F, <i>n</i> = 10) and nonsuctioning mPCNL (ns-mPCNL) with a metallic dilator and sheath (Storz MIP-M™, 17.5F, <i>n</i> = 10). A group of 10 patients undergoing sPCNL using a balloon dilator with a Polytetrafluoroethylene (PTFE) sheath (NephroMax™, 24F, <i>n</i> = 10) were included as a control. IRP was measured with a 0.014″ COMET™ II Pressure guidewire retrogradely positioned in the renal pelvis. Gravity irrigation was utilized. Pressure data captured include baseline IRPs, retrograde pyelogram (RPG), needle entry, fascial dilation, tract dilation, sheath insertion, nephroscopy, and lithotripsy. The primary outcome was differences in mean and peak IRP during each stage. Categorical data were compared using chi-square or Fisher's exact tests. Continuous variables were analyzed using one-way analysis of variance. <b><i>Results:</i></b> Peak and mean IRPs (millimeters of mercury or mm Hg) were similar at baseline and during RPG, needle insertion, and fascial dilation in the two experimental groups and in the control group. During tract dilation and sheath placement, both the mPCNL sheaths generated much higher peak IRP compared with the 24F balloon dilation control group but similar to each other (dilation: 36.6 and 38.6 vs 6.9, <i>p</i> < 0.001; sheath placement: 36.6 and 35.3 vs 13.8, <i>p </i>= 0.039). During nephroscopy, ns-mPCNL generated greater peak IRP compared with s-mPCNL and the control group (41.8 vs 19.09 and 24.15; <i>p</i> = 0.019). The highest peak IRP for each group occurred during RPG and when a nephroscope was placed through a narrow infundibulum. <b><i>Conclusions:</i></b> Compared with balloon dilation, coaxial dilation with mPCNL sheaths generates significantly higher IRP. During nephroscopy, ns-mPCNL sheaths generate higher IRP compared with standard and suctioning sheaths. Highest IRPs are generated during RPG and when a nephroscope goes through a narrow infundibulum. These findings can inform improved sheath and nephroscope design. Further research assessing the effect of high IRP on postoperative pain, sepsis, and renal injury is needed.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"214-221"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}