Micro-ureteroscopy vs. ureteroscopy: effects of miniaturization on renal vascularization and intrapelvic pressure
Por:
Caballero J, Galan J, Soria F, Morcillo-Martín E, Caballero-Pérez P, Garcia A, De La Cruz-Conty JE and Romero-Maroto J
Publicada:
1 may 2018
Categoría:
Urology
Resumen:
Purpose Ureteroscopy (URS) is related to complications, as fever or postoperative urinary sepsis, due to high intrapelvic pressure (IPP) during the procedure. Micro-ureteroscopy (m-URS) aims to reduce morbidity by miniaturizing the instrument. The objective of this study is to compare IPP and changes in renal haemodynamics, while performing m-URS vs. conventional URS.
Methods A porcine model involving 14 female pigs was used in this experimental study. Two surgeons performed 7 URS (8/9.8 Fr), for 45 min, and 7 m-URS (4.85 Fr), for 60 min, representing a total of 28 procedures in 14 animals. A catheter pressure transducer measured IPP every 5 min. Haemodynamic parameters were evaluated by Doppler ultrasound. The volume of irrigation fluid employed in each procedure was also measured.
Results The range of average pressures was 5.08-14.1 mmHg in the m-URS group and 6.08-20.64 mmHg in the URS (NS). 30 mmHg of IPP were not reached in 90% of renal units examined with m-URS, as compared to 65% of renal units in the URS group. Mean peak diastolic velocity decreased from 15.93 to 15.22 cm/s (NS) in the URS group and from 19.26 to 12.87 cm/s in the m-URS group (p < 0.01). Mean resistive index increased in both groups (p < 0.01). Irrigation fluid volume used was 485 mL in the m-URS group and 1475 mL in the URS group (p < 0.001).
Conclusions m-URS requires less saline irrigation volumes than the conventional ureteroscopy and increases renal IPP to a lesser extent.
Filiaciones:
Caballero J:
Univ Hosp Vinalopo, Alicante Inst Hlth & Biomed Res, ISABIAL FISABIO Fdn, Dept Urol, Carrer Tonico Sansano Mora 14, Alicante 03293, Spain
Urology Department, University Hospital of Vinalopó, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Carrer Tonico Sansano Mora, 14, Elche, 03293, Alicante, Spain.
Galan J:
Univ Hosp Vinalopo, Alicante Inst Hlth & Biomed Res, ISABIAL FISABIO Fdn, Dept Urol, Carrer Tonico Sansano Mora 14, Alicante 03293, Spain
Urology Department, University Hospital of Vinalopó, Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Carrer Tonico Sansano Mora, 14, Elche, 03293, Alicante, Spain
Soria F:
Jesus Uson Minimally Invas Surg Ctr, Endoscopy Unit, Carretera N-521,Km 41,8, Caceres 10071, Spain
Endoscopy Unit, Jesús Usón Minimally Invasive Surgery Center, Carretera N-521, km. 41,8, 10071, Cáceres, Spain
Morcillo-Martín E:
Jesus Uson Minimally Invas Surg Ctr, Endoscopy Unit, Carretera N-521,Km 41,8, Caceres 10071, Spain
Endoscopy Unit, Jesús Usón Minimally Invasive Surgery Center, Carretera N-521, km. 41,8, 10071, Cáceres, Spain
:
Univ Alicante, Community Nursing Prevent Med & Publ Hlth & Hist, Carretera San Vicente del Raspeig S-N, Alicante 03690, Spain
Community Nursing, Preventive Medicine and Public Health and History of Science Department, University of Alicante, Carretera San Vicente del Raspeig, s/n, San Vicente del Raspeig, 03690, Alicante, Spain
:
Elche Univ Gen Hosp, Dept Urol, Cami Almazara 11, Alicante 03203, Spain
Urology Department, Elche University General Hospital, Camí de l´Almazara, 11, Elche, 03203, Alicante, Spain
De La Cruz-Conty JE:
Jesus Uson Minimally Invas Surg Ctr, Endoscopy Unit, Carretera N-521,Km 41,8, Caceres 10071, Spain
Endoscopy Unit, Jesús Usón Minimally Invasive Surgery Center, Carretera N-521, km. 41,8, 10071, Cáceres, Spain
:
San Juan Univ Clin Hosp, Dept Urol, Ctra Nnal 332, Alicante 03550, Spain
Miguel Hernandez Univ, Alicante, Spain
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