Pressure Matters 2: Intrarenal Pressure Ranges During Upper-tract Endourological Procedures

Overview

Journal World J Urol

Specialty Urology

Date 2018 Jun 20

PMID 29915944

Citations 34

Authors

Theodoros Tokas

Andreas Skolarikos

Thomas R W Herrmann

Udo Nagele

Affiliations

Soon will be listed here.

Abstract

Purpose: To perform a review on the latest evidence related to intrarenal pressures (IRPs) generated during upper-tract endourology, and present different tools to maintain decreased values, to decrease complication rates.

Methods: A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal-pelvic pressure.

Results: IRPs reported during retrograde intrarenal surgery (RIRS), PCNL, miniPCNL, and microPCNL range 40.8-199.35, 3-40.8, 10-45 and 15.37-41.21 cm HO, respectively. By utilizing ureteral access sheaths (UASs) IRPs usually remain lower than 30 cm HO at an irrigation pressure (IP) of ≤ 100 cm HO but could increase to > 40 cm HO at an IP of 200 cm HO. By utilizing the minimally invasive PCNL system, IRPs remain low at 20 cm HO even at high IPs. Utilizing endoluminal isoproterenol during RIRS, could reduce IRP increases with a rate of 27-107%, and maintain low IRPs values, usually below 50 cm HO.

Conclusions: Increased IRP values have been reported during RIRS and UASs constitute the most efficient tool for decreasing them. IRPs during mini-PCNL can be decreased utilizing the vacuum-cleaner and purging effects but might remain uncontrolled during micro- and ultra-mini PCNL. Intraluminal pharmacological treatment could play a role in IRP decrease, with isoproterenol being the most studied agent.

Citing Articles

Intrarenal Pressure Monitoring During Ureteroscopy: A Delphi Panel Consensus.

Somani B, Davis N, Emiliani E, Gocke M, Jung H, Keller E Eur Urol Open Sci. 2025; 73:43-50.

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Impact of pre-stenting and bladder dranaige on intrapelvic pressure during retrograde intrarenal surgery.

Yeni S, Kilicarslan H, Ocakoglu G, Coskun B, Cicek M, Gunseren K BJUI Compass. 2025; 6(2):e490.

PMID: 39917584 PMC: 11794232. DOI: 10.1002/bco2.490.

Total tubeless percutaneous nephrolithotomy without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis: a randomized controlled trial.

Fu X, Hu W, Deng W, Jin W, Zu X, Zhu G Int Urol Nephrol. 2024; 57(3):759-767.

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In the Treatment of Lower Pole Kidney Stones Between 1-2 cm in Children, Which is the Best Approach? Retrograde Intrarenal Surgery or Mini Percutaneous Nephrolithotomy.

Arikan Y, Dumanli E, Alper Kara Y, Kumcu A, Keskin M, Can Erdogan U Sisli Etfal Hastan Tıp Bul. 2024; 58(3):332-338.

PMID: 39411045 PMC: 11472195. DOI: 10.14744/SEMB.2024.49225.

The Evaluation of Intrarenal Pressure Using a Novel Single-Use Flexible Ureteroscope with Live Intrarenal Pressure Monitoring-An Experimental Study in Porcine Models.

Samaras A, Tatanis V, Peteinaris A, Obaidat M, Faitatziadis S, Vagionis A Life (Basel). 2024; 14(9).

PMID: 39337845 PMC: 11433279. DOI: 10.3390/life14091060.

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