PMID- 35485243
OWN - NLM
STAT- MEDLINE
DCOM- 20230224
LR  - 20230227
IS  - 1464-410X (Electronic)
IS  - 1464-4096 (Linking)
VI  - 131
IP  - 3
DP  - 2023 Mar
TI  - Upper urinary tract pressures in endourology: a systematic review of range, 
      variables and implications.
PG  - 267-279
LID - 10.1111/bju.15764 [doi]
AB  - OBJECTIVES: To systematically review the literature to ascertain the upper tract 
      pressures generated during endourology, the relevant influencing variables and 
      clinical implications. MATERIALS AND METHODS: A systematic review of the MEDLINE, 
      Scopus and Cochrane databases was performed by two authors independently (S.C., 
      N.D.). Studies reporting ureteric or intrarenal pressures (IRP) during semi-rigid 
      ureteroscopy (URS)/flexible ureterorenoscopy (fURS)/percutaneous nephrolithotomy 
      (PCNL)/miniaturized PCNL (mPCNL) in the period 1950-2021 were identified. Both 
      in vitro and in vivo studies were considered for inclusion. Findings were 
      independently screened for eligibility based on content, with disagreements 
      resolved by author consensus. Data were assessed for bias and compiled based on 
      predefined variables. RESULTS: Fifty-two studies met the inclusion criteria. Mean 
      IRP appeared to frequently exceed a previously proposed threshold of 40 cmH(2) O. 
      Semi-rigid URS with low-pressure irrigation (gravity <1 m) resulted in a wide 
      mean IRP range (lowest reported 6.9 cmH(2) O, highest mean 149.5 +/- 6.2 cmH(2) O; 
      animal models). The lowest mean observed with fURS without a ureteric access 
      sheath (UAS) was 47.6 +/- 4.1 cmH(2) O, with the maximum peak IRP being 557.4 
      cmH(2) O (in vivo human data). UAS placement significantly reduced IRP during 
      fURS, but did not guarantee pressure control with hand-operated pump/syringe 
      irrigation. Miniaturization of PCNL sheaths was associated with increased IRP; 
      however, a wide mean human IRP range has been recorded with both mPCNL (lowest 
      -6.8 +/- 2.2 cmH(2) O [suction sheath]; highest 41.2 +/- 5.3 cmH(2) O) and standard 
      PCNL (lowest 6.5 cmH(2) O; highest 41.2 cmH(2) O). Use of continuous suction in 
      mPCNL results in greater control of mean IRP, although short pressure peaks >40 
      cmH(2) O are not entirely prevented. Definitive conclusions are limited by 
      heterogeneity in study design and results. Postoperative pain and pyrexia may be 
      correlated with increased IRP, however, few in vivo studies correlate clinical 
      outcome with measured IRP. CONCLUSIONS: Intrarenal pressure generated during 
      upper tract endoscopy often exceeds 40 cmH(2) O. IRP is multifactorial in origin, 
      with contributory variables discussed. Larger prospective human in vivo studies 
      are required to further our understanding of IRP thresholds and clinical 
      sequelae.
CI  - (c) 2022 The Authors. BJU International published by John Wiley & Sons Ltd on 
      behalf of BJU International.
FAU - Croghan, Stefanie M
AU  - Croghan SM
AUID- ORCID: 0000-0003-4524-3682
AD  - Royal College of Surgeons, Dublin, Ireland.
AD  - Department of Urology, Blackrock Clinic, Dublin, Ireland.
FAU - Skolarikos, Andreas
AU  - Skolarikos A
AD  - European Association of Urology Urolithiasis Guidelines, Arnhem, The Netherlands.
AD  - Department of Urology, National and Kapodistrian University of Athens, Athens, 
      Greece.
FAU - Jack, Gregory S
AU  - Jack GS
AD  - Department of Urology, Austin Health, University of Melbourne, Parkville, VIC, 
      Australia.
FAU - Manecksha, Rustom P
AU  - Manecksha RP
AD  - Department of Urology, Tallaght University Hospital, Dublin, Ireland.
AD  - Department of Urology, St. James's Hospital, Dublin, Ireland.
AD  - Department of Surgery, Trinity College Dublin, Dublin, Ireland.
FAU - Walsh, Michael T
AU  - Walsh MT
AD  - School of Engineering, Bernal Institute, University of Limerick, Limerick, 
      Ireland.
AD  - Health Research Institute, University of Limerick, Limerick, Ireland.
FAU - O'Brien, Fergal J
AU  - O'Brien FJ
AD  - Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, 
      Ireland.
FAU - Davis, Niall F
AU  - Davis NF
AUID- ORCID: 0000-0002-5298-1475
AD  - Royal College of Surgeons, Dublin, Ireland.
AD  - Department of Urology, Blackrock Clinic, Dublin, Ireland.
AD  - European Association of Urology Urolithiasis Guidelines, Arnhem, The Netherlands.
AD  - Department of Urology, Beaumont Hospital, Dublin, Ireland.
LA  - eng
GR  - Royal College of Surgeons in Ireland/
GR  - Royal College/
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
DEP - 20220705
PL  - England
TA  - BJU Int
JT  - BJU international
JID - 100886721
SB  - IM
MH  - Animals
MH  - Humans
MH  - Prospective Studies
MH  - Ureteroscopy/methods
MH  - *Ureter
MH  - *Nephrolithotomy, Percutaneous/methods
MH  - Ureteroscopes
MH  - *Kidney Calculi/surgery
OTO - NOTNLM
OT  - kidney
OT  - nephrolithotomy
OT  - percutaneous
OT  - pressure
OT  - treatment outcome
OT  - ureteroscopy (+intra-renal; iyeloscopy; endourology)
EDAT- 2022/04/30 06:00
MHDA- 2023/02/25 06:00
CRDT- 2022/04/29 05:12
PHST- 2022/04/30 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2022/04/29 05:12 [entrez]
AID - 10.1111/bju.15764 [doi]
PST - ppublish
SO  - BJU Int. 2023 Mar;131(3):267-279. doi: 10.1111/bju.15764. Epub 2022 Jul 5.