To review the latest evidence on the complications of elevated intrarenal pressures (IRPs) in retrograde intrarenal surgery (RIRS) and the strategies to mitigate the increase of IRP during surgery.
A literature search of the PubMed, MEDLINE, and Google Scholar databases was conducted from inception to April 2024. The analysis involved a narrative review.
Normal physiological IRP in an unobstructed kidney ranges from 0 to 15 mmHg (0-20 cmH2O). During RIRS, dangerous IRPs are often reached, resulting in complications. These include pyelorenal reflux, which predisposes the patient to fever, urosepsis and postoperative pain, and forniceal rupture, which may result in intraoperative bleeding as well as acute kidney injury, post-operative pain and fluid overload. To maintain safe IRP, outflow should be as close as possible to inflow. Minimising the irrigation pressure by controlling the flow rate, reducing the pressure of the irrigant fluid, using a ureteral access sheath and maintaining an empty bladder during the procedure and, more recently, using real-time intrarenal pressure monitoring are appropriate techniques to mitigate unsafe IRPs.
Several complications from RIRS are related to elevated IRPs. Urologists need to understand the concept of IRP in endourology, the dangers associated with an elevated IRP, and the techniques that may be used to mitigate unsafe IRPs.
Urology. 2024 Sep 23 [Epub ahead of print]
Jeff John, Pawel Wisniewski, Graham Fieggen, Lisa Kaestner, John Lazarus
Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa; Division of Urology, Department of Surgery, Frere Hospital and Walter Sisulu University, East London, South Africa. Electronic address: ., Hillcrest Private Hospital, Durban, South Africa., Division of Neurosurgery, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa., Division of Urology, Department of Surgery, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.