Introduction: Intrarenal pressure is emerging as an important monitoring parameter during flexible ureteroscopy (fURS). We measure how intraoperative conditions affect intrarenal pressure using a novel pressure sensing ureteroscope. Methods: The LithoVue Elite (LVE) single-use digital flexible ureteroscope (Boston Scientific) is the first commercial ureteroscope that senses pressure at its tip. LVE was used in a porcine model to measure intrarenal pressure with and without a ureteral access sheath (UAS) with various sizes and placement locations, irrigation methods, and working channel accessories. LVE pressure accuracy was measured in a bench model. This abstract shows the least-square means from multiway analysis of variances used for analysis. Results: Intrarenal pressures were the highest without a UAS (64 mm Hg), followed by the 11/13 UAS (51 mm Hg) and the 12/14 and 13/15, which were not statistically different (39-40 mm Hg). The pressures were highest with UASs placed at the ureteropelvic junction (61 mm Hg), and lowest if placed in the renal pelvis (24 mm Hg). Irrigation methods showed the highest pressures with syringe (57 mm Hg), while irrigation bags (pressurized at 150-300 mm Hg) produced 43 to 46 mm Hg and 25 mm Hg when applied with 80 cm of gravity. Placing a 200 μm laser fiber reduced pressures from 44 to 41 mm Hg. Finally, the bench model showed that LVE was 96% accurate up to 300 mm Hg. Conclusion: Intrarenal pressure significantly varied based on UAS sizes, placement, and irrigation methods. Accordingly, fURS with LVE is poised to be an invaluable tool for clinical decision-making and future studies of intrarenal pressure.

中文翻译：

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使用具有压力传感功能的新型输尿管软镜测量肾内压力：输尿管通路鞘、冲洗和工作通道附件的影响的研究。

简介：肾内压正在成为输尿管软镜检查 (fURS) 期间的一个重要监测参数。我们使用新型压力传感输尿管镜来测量术中条件如何影响肾内压力。方法：LithoVue Elite (LVE) 一次性数字输尿管软镜 (Boston Scientific) 是第一款可感知其尖端压力的商用输尿管镜。LVE 在猪模型中用于测量有或没有输尿管通路鞘 (UAS) 的肾内压力，UAS 具有各种尺寸和放置位置、冲洗方法和工作通道附件。LVE 压力精度是在台架模型中测量的。本摘要显示了用于分析的多路方差分析的最小二乘均值。结果：不使用 UAS 时肾内压最高（64 mm Hg），其次是 11/13 UAS（51 mm Hg）以及 12/14 和 13/15，没有统计学差异（39-40 mm Hg） 。当 UAS 放置在肾盂输尿管交界处时，压力最高 (61 mm Hg)；如果放置在肾盂中，则压力最低 (24 mm Hg)。灌溉方法显示，使用注射器的压力最高（57 毫米汞柱），而灌溉袋（加压至 150-300 毫米汞柱）可产生 43 至 46 毫米汞柱，施加 80 厘米重力时可产生 25 毫米汞柱。放置 200 μm 激光纤维可将压力从 44 毫米汞柱降低至 41 毫米汞柱。最后，台式模型显示 LVE 在高达 300 mm Hg 的情况下准确度为 96%。结论：肾内压根据 UAS 尺寸、放置和冲洗方法的不同而显着变化。因此，fURS 与 LVE 有望成为临床决策和未来肾内压研究的宝贵工具。