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Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model.
Lee, Matthew S; Connors, Bret A; Agarwal, Deepak K; Assmus, Mark A; Williams, James C; Large, Tim; Krambeck, Amy E.
Afiliação
  • Lee MS; Department of Urology, Ohio State University, Columbus, OH, USA. Matthew.lee@osumc.edu.
  • Connors BA; Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
  • Agarwal DK; Department of Urology, University of Minnesota, Minneapolis, MN, USA.
  • Assmus MA; University of Calgary, Southern Alberta Institute of Urology, Calgary, Alberta, Canada.
  • Williams JC; Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA.
  • Large T; Department of Urology, Indiana University School of Medicine, Methodist Hospital, Indianapolis, IN, USA.
  • Krambeck AE; School of Medicine, Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, USA.
World J Urol ; 40(11): 2675-2681, 2022 Nov.
Article em En | MEDLINE | ID: mdl-36136130
PURPOSE: To identify a threshold for intrarenal pressure (IRP), that if exceeded, will result in renal parenchymal damage. Herein, we attempt to identify an IRP threshold by subjecting in vivo porcine kidneys to various levels of extreme pressurized irrigation. Our objective was not to simulate ureteroscopy treatment, but to attempt identify a threshold of IRP injury. METHODS: Ten female pigs were intubated and sedated. The abdomen was opened; the ureters were isolated and incised. A LithoVue™ (Boston Scientific) ureteroscope was inserted. A 0-silk tie was then used to tie the ureter around the scope to create a closed system (to achieve a constant level of pressure). Real-time IRPs were measured using the Comet™ Pressure guidewire (Boston Scientific). Kidneys were exposed to pressurized, saline for 36 min (at control, 50, 100, 150 mmHg and higher pressures). Kidneys were then immediately harvested. Two expert histologists independently analyzed kidney slides to identify areas of renal damage. RESULTS: The two kidneys exposed to IRPs > 185 mmHg resulted in forniceal rupture and large areas of hematoma. The other IRP groups (control, 50, 100, and 150 mmHg) had no identifiable gross or histologic renal parenchymal damage. CONCLUSIONS: No differences in renal parenchymal morphology were identified between pressure groups of control, 50, 100, or 150 mmHg. However, IRPs > 185 mmHg did result in forniceal rupture in this closed-system in vivo porcine model. Further study is required to elucidate the damage threshold.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ureteroscopia / Ureteroscópios Limite: Animals Idioma: En Ano de publicação: 2022 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Ureteroscopia / Ureteroscópios Limite: Animals Idioma: En Ano de publicação: 2022 Tipo de documento: Article