To review the latest evidence about intrarenal pressures (IRPs) generated during flexible ureteroscopy (fURS) and mini percutaneous nephrolithotomy (mPCNL) and present tools and techniques to maintain decreased values.
fURS and PCNL constitute the primary means of stone treatment. New flexible ureterorenoscopes with small diameter and miniaturized PCNL instruments achieve optimal stone-free rates (SFRs) while decreasing invasiveness and morbidity. Nevertheless, endourologists must remain cognizant regarding the dangers of increased IRPs to avoid complications. Current research presents essential information for urologists regarding this topic. During fURS, using a ureteral access sheath (UAS), we avoid extremely high IRPs with all irrigation types. During mPCNL, pressure remains low, mainly using the purging effect or a vacuum-assisted sheath. Devices of intraoperative IRP measurement and intelligent pressure control have proven their feasibility, accuracy and efficacy. These will have an increasing role to play in the future management of stone disease.
Current urology reports. 2021 Oct 08*** epublish ***
Theodoros Tokas, Eirini Tzanaki, Udo Nagele, Bhaskar Kumar Somani
Department of Urology and Andrology, General Hospital Hall I.T, Milser Str. 10, 6060, Hall i.T., Hall in Tirol, Austria. ., Medical School, University of Pavia, Harvey Course, Pavia, Italy., Department of Urology and Andrology, General Hospital Hall I.T, Milser Str. 10, 6060, Hall i.T., Hall in Tirol, Austria., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK.