International urology and nephrology · 2025
Intrarenal pressure during the flexible and navigable suction ureteral access sheath-assisted retrograde intrarenal surgery: a two-center study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Kayano Sotaro, Yanagisawa Takafumi, Shibata Ken, Nishi Eriko, Yata Yuji, Miyajima Keiichiro, Fujisawa Naoki, Yasuda Yuka, Maiya Shigetoshi, Shinozaki Tetsuo, Yuen Steffi Kar Kei, Simomura Tatsuya, Kimura Takahiro
Аннотация
PURPOSE: To evaluate intrarenal pressure (IRP) during flexible and navigable suction ureteral access sheath (FANS)-assisted retrograde intrarenal surgery (RIRS), and to identify clinical factors influencing increased IRP.
METHODS: This retrospective study included 30 consecutive patients who underwent FANS-assisted RIRS using the LithoVue™ Elite ureteroscope (Boston Scientific, Marlborough, USA) at two Japanese centers between October 2024 and May 2025. Two types of 12/14 Fr FANS, Clear Petra™ (Wellead Medical, Guangzhou, China) and NOVAGATE™ (Dornier MedTech, Zhejiang, China) were utilized. IRP was evaluated during the lithotripsy phase. Various IRP metrics were analyzed, including the median, maximum, time-weighted mean, percentage of time above thresholds (> 20, > 30, and > 40 mmHg), and area under the curve (AUC). Factors related to % time > 30 mmHg were assessed, and temporal changes in IRP were compared across four equal surgical intervals.
RESULTS: The median % time > 20, > 30, and > 40 mmHg were 22.7% (IQR 5-52.1), 3.31% (0.8-13.5), and 0.01% (0-3.3), respectively. % time > 30 mmHg was significantly greater when the FANS tip was positioned at the ureteropelvic junction than within the renal pelvis (10.4 vs 1.2%, p = 0.02) and in staghorn cases (11.3 vs 1.1%, p = 0.01). No significant differences were observed across the four surgical intervals (p = 0.85). No postoperative febrile urinary tract infections occurred. There were no cases of postoperative febrile urinary tract infection.
CONCLUSIONS: FANS-assisted RIRS allowed real-time monitoring and overall maintenance of low intrarenal pressure. Staghorn calculi and sheath tip position were associated with pressure elevation. The generalizability is limited as only 12/14 Fr sheaths were included.
METHODS: This retrospective study included 30 consecutive patients who underwent FANS-assisted RIRS using the LithoVue™ Elite ureteroscope (Boston Scientific, Marlborough, USA) at two Japanese centers between October 2024 and May 2025. Two types of 12/14 Fr FANS, Clear Petra™ (Wellead Medical, Guangzhou, China) and NOVAGATE™ (Dornier MedTech, Zhejiang, China) were utilized. IRP was evaluated during the lithotripsy phase. Various IRP metrics were analyzed, including the median, maximum, time-weighted mean, percentage of time above thresholds (> 20, > 30, and > 40 mmHg), and area under the curve (AUC). Factors related to % time > 30 mmHg were assessed, and temporal changes in IRP were compared across four equal surgical intervals.
RESULTS: The median % time > 20, > 30, and > 40 mmHg were 22.7% (IQR 5-52.1), 3.31% (0.8-13.5), and 0.01% (0-3.3), respectively. % time > 30 mmHg was significantly greater when the FANS tip was positioned at the ureteropelvic junction than within the renal pelvis (10.4 vs 1.2%, p = 0.02) and in staghorn cases (11.3 vs 1.1%, p = 0.01). No significant differences were observed across the four surgical intervals (p = 0.85). No postoperative febrile urinary tract infections occurred. There were no cases of postoperative febrile urinary tract infection.
CONCLUSIONS: FANS-assisted RIRS allowed real-time monitoring and overall maintenance of low intrarenal pressure. Staghorn calculi and sheath tip position were associated with pressure elevation. The generalizability is limited as only 12/14 Fr sheaths were included.