Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths

Jamil Rehman, Manoj Monga, Jaime Landman, David I. Lee, Tamer Felfela, Marius C. Conradie, Rajamahanty Srinivas, Chandru Sundaram, Ralph V. Clayman

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Objectives. To evaluate the impact of the ureteral access sheath on intrarenal pressures during flexible ureteroscopy in light of the recent resurgence in their use. As such, using human cadaveric kidneys, we studied changes in intrarenal pressure in response to continuous irrigation at different pressures with and without access sheaths of various sizes and lengths. Methods. This study was performed using seven cadaveric kidneys. In three kidneys the study was done in situ with a 7.5F flexible ureteroscope (URS) passed by itself and then passed through a 10/12F sheath (35 and 55 cm in length), whereas, in four kidneys, due to narrowing of the intramural ureter, the study was done ex vivo using the unsheathed URS and then passing the 7.5F flexible URS via the 10/12F, 12/14F, and 14/16F sheaths (all 35 cm in length). A 10F Cope loop pyelostomy was placed to measure intrapelvic renal pressure. Three sets of 3-minute readings (ie, flow and intrarenal pressure) were taken with the tip of the URS at the distal ureter, middle ureter, and renal pelvis (just above the ureteropelvic junction); the entire process was done at three different irrigant pressure settings: 50, 100, and 200 cm H2O. Irrigant flow and intrarenal pressures were measured at all three settings using the URS passed without a sheath and then with the URS passed through the various sheaths positioned at the distal ureter, middle ureter, and renal pelvis. Results With all of the sheaths, intrapelvic pressure remained low (less than 30 cm H2O), and there was a 35% to 80% increase in irrigant flow versus the control unsheathed URS. With the sheath in place, the majority of the irrigant drained alongside the URS and out the sheath. Flow and pressure with the 12/14F sheath were equivalent to the 14/16F sheath. Conclusions. The 12/14F access sheath provides for maximum flow of irrigant while maintaining a low intrarenal pelvic pressure. Even with an irrigation pressure of 200 cm H2O, renal pelvic pressure remained below 20 cm H2O.

Original languageEnglish (US)
Pages (from-to)713-718
Number of pages6
JournalUrology
Volume61
Issue number4
DOIs
StatePublished - Apr 1 2003
Externally publishedYes

Fingerprint

Ureteroscopes
Pressure
Ureter
Kidney
Kidney Pelvis
Ureteroscopy
Reading

ASJC Scopus subject areas

  • Urology

Cite this

Rehman, J., Monga, M., Landman, J., Lee, D. I., Felfela, T., Conradie, M. C., ... Clayman, R. V. (2003). Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology, 61(4), 713-718. https://doi.org/10.1016/S0090-4295(02)02440-8

Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. / Rehman, Jamil; Monga, Manoj; Landman, Jaime; Lee, David I.; Felfela, Tamer; Conradie, Marius C.; Srinivas, Rajamahanty; Sundaram, Chandru; Clayman, Ralph V.

In: Urology, Vol. 61, No. 4, 01.04.2003, p. 713-718.

Research output: Contribution to journalArticle

Rehman, J, Monga, M, Landman, J, Lee, DI, Felfela, T, Conradie, MC, Srinivas, R, Sundaram, C & Clayman, RV 2003, 'Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths', Urology, vol. 61, no. 4, pp. 713-718. https://doi.org/10.1016/S0090-4295(02)02440-8
Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC et al. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003 Apr 1;61(4):713-718. https://doi.org/10.1016/S0090-4295(02)02440-8
Rehman, Jamil ; Monga, Manoj ; Landman, Jaime ; Lee, David I. ; Felfela, Tamer ; Conradie, Marius C. ; Srinivas, Rajamahanty ; Sundaram, Chandru ; Clayman, Ralph V. / Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. In: Urology. 2003 ; Vol. 61, No. 4. pp. 713-718.
@article{b719ba9de6db4add9477d6b1328fb786,
title = "Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths",
abstract = "Objectives. To evaluate the impact of the ureteral access sheath on intrarenal pressures during flexible ureteroscopy in light of the recent resurgence in their use. As such, using human cadaveric kidneys, we studied changes in intrarenal pressure in response to continuous irrigation at different pressures with and without access sheaths of various sizes and lengths. Methods. This study was performed using seven cadaveric kidneys. In three kidneys the study was done in situ with a 7.5F flexible ureteroscope (URS) passed by itself and then passed through a 10/12F sheath (35 and 55 cm in length), whereas, in four kidneys, due to narrowing of the intramural ureter, the study was done ex vivo using the unsheathed URS and then passing the 7.5F flexible URS via the 10/12F, 12/14F, and 14/16F sheaths (all 35 cm in length). A 10F Cope loop pyelostomy was placed to measure intrapelvic renal pressure. Three sets of 3-minute readings (ie, flow and intrarenal pressure) were taken with the tip of the URS at the distal ureter, middle ureter, and renal pelvis (just above the ureteropelvic junction); the entire process was done at three different irrigant pressure settings: 50, 100, and 200 cm H2O. Irrigant flow and intrarenal pressures were measured at all three settings using the URS passed without a sheath and then with the URS passed through the various sheaths positioned at the distal ureter, middle ureter, and renal pelvis. Results With all of the sheaths, intrapelvic pressure remained low (less than 30 cm H2O), and there was a 35{\%} to 80{\%} increase in irrigant flow versus the control unsheathed URS. With the sheath in place, the majority of the irrigant drained alongside the URS and out the sheath. Flow and pressure with the 12/14F sheath were equivalent to the 14/16F sheath. Conclusions. The 12/14F access sheath provides for maximum flow of irrigant while maintaining a low intrarenal pelvic pressure. Even with an irrigation pressure of 200 cm H2O, renal pelvic pressure remained below 20 cm H2O.",
author = "Jamil Rehman and Manoj Monga and Jaime Landman and Lee, {David I.} and Tamer Felfela and Conradie, {Marius C.} and Rajamahanty Srinivas and Chandru Sundaram and Clayman, {Ralph V.}",
year = "2003",
month = "4",
day = "1",
doi = "10.1016/S0090-4295(02)02440-8",
language = "English (US)",
volume = "61",
pages = "713--718",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths

AU - Rehman, Jamil

AU - Monga, Manoj

AU - Landman, Jaime

AU - Lee, David I.

AU - Felfela, Tamer

AU - Conradie, Marius C.

AU - Srinivas, Rajamahanty

AU - Sundaram, Chandru

AU - Clayman, Ralph V.

PY - 2003/4/1

Y1 - 2003/4/1

N2 - Objectives. To evaluate the impact of the ureteral access sheath on intrarenal pressures during flexible ureteroscopy in light of the recent resurgence in their use. As such, using human cadaveric kidneys, we studied changes in intrarenal pressure in response to continuous irrigation at different pressures with and without access sheaths of various sizes and lengths. Methods. This study was performed using seven cadaveric kidneys. In three kidneys the study was done in situ with a 7.5F flexible ureteroscope (URS) passed by itself and then passed through a 10/12F sheath (35 and 55 cm in length), whereas, in four kidneys, due to narrowing of the intramural ureter, the study was done ex vivo using the unsheathed URS and then passing the 7.5F flexible URS via the 10/12F, 12/14F, and 14/16F sheaths (all 35 cm in length). A 10F Cope loop pyelostomy was placed to measure intrapelvic renal pressure. Three sets of 3-minute readings (ie, flow and intrarenal pressure) were taken with the tip of the URS at the distal ureter, middle ureter, and renal pelvis (just above the ureteropelvic junction); the entire process was done at three different irrigant pressure settings: 50, 100, and 200 cm H2O. Irrigant flow and intrarenal pressures were measured at all three settings using the URS passed without a sheath and then with the URS passed through the various sheaths positioned at the distal ureter, middle ureter, and renal pelvis. Results With all of the sheaths, intrapelvic pressure remained low (less than 30 cm H2O), and there was a 35% to 80% increase in irrigant flow versus the control unsheathed URS. With the sheath in place, the majority of the irrigant drained alongside the URS and out the sheath. Flow and pressure with the 12/14F sheath were equivalent to the 14/16F sheath. Conclusions. The 12/14F access sheath provides for maximum flow of irrigant while maintaining a low intrarenal pelvic pressure. Even with an irrigation pressure of 200 cm H2O, renal pelvic pressure remained below 20 cm H2O.

AB - Objectives. To evaluate the impact of the ureteral access sheath on intrarenal pressures during flexible ureteroscopy in light of the recent resurgence in their use. As such, using human cadaveric kidneys, we studied changes in intrarenal pressure in response to continuous irrigation at different pressures with and without access sheaths of various sizes and lengths. Methods. This study was performed using seven cadaveric kidneys. In three kidneys the study was done in situ with a 7.5F flexible ureteroscope (URS) passed by itself and then passed through a 10/12F sheath (35 and 55 cm in length), whereas, in four kidneys, due to narrowing of the intramural ureter, the study was done ex vivo using the unsheathed URS and then passing the 7.5F flexible URS via the 10/12F, 12/14F, and 14/16F sheaths (all 35 cm in length). A 10F Cope loop pyelostomy was placed to measure intrapelvic renal pressure. Three sets of 3-minute readings (ie, flow and intrarenal pressure) were taken with the tip of the URS at the distal ureter, middle ureter, and renal pelvis (just above the ureteropelvic junction); the entire process was done at three different irrigant pressure settings: 50, 100, and 200 cm H2O. Irrigant flow and intrarenal pressures were measured at all three settings using the URS passed without a sheath and then with the URS passed through the various sheaths positioned at the distal ureter, middle ureter, and renal pelvis. Results With all of the sheaths, intrapelvic pressure remained low (less than 30 cm H2O), and there was a 35% to 80% increase in irrigant flow versus the control unsheathed URS. With the sheath in place, the majority of the irrigant drained alongside the URS and out the sheath. Flow and pressure with the 12/14F sheath were equivalent to the 14/16F sheath. Conclusions. The 12/14F access sheath provides for maximum flow of irrigant while maintaining a low intrarenal pelvic pressure. Even with an irrigation pressure of 200 cm H2O, renal pelvic pressure remained below 20 cm H2O.

UR - http://www.scopus.com/inward/record.url?scp=0037381258&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037381258&partnerID=8YFLogxK

U2 - 10.1016/S0090-4295(02)02440-8

DO - 10.1016/S0090-4295(02)02440-8

M3 - Article

C2 - 12670551

AN - SCOPUS:0037381258

VL - 61

SP - 713

EP - 718

JO - Urology

JF - Urology

SN - 0090-4295

IS - 4

ER -