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Characterization of intracalyceal pressure during ureteroscopy

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Abstract

Purpose

To provide the first report of measuring intracalyceal pressures during ureteroscopy (URS).

Methods

A prospective single-center clinical study using a cardiac pressure guidewire to measure intracalyceal pressure during flexible URS was performed. Eight patients (45 calyces) undergoing URS for nephrolithiasis were included. A Verrata® pressure guide wire was passed through the working channel of a dual lumen flexible ureteroscope and into the calyces while irrigation was maintained at 150 mmHg. Pressure was measured in the renal pelvis, upper pole, interpolar, and lower pole calyces both with and without a ureteral access sheath (UAS). The pressure in each location with and without a UAS was compared. The correlation between calyceal pressure and infundibular dimensions (width, length) was determined.

Results

Intracalyceal pressure was significantly lower in each region when a UAS was used. Compared to patients with a 12/14Fr UAS, those with a 14/16Fr UAS had significantly lower pressure in the interpolar (25.3 ± 13.1 vs. 44.0 ± 27.5 mmHg, p = 0.03) and lower pole (16.2 ± 3.5 vs. 49.2 ± 40.3 mmHg, p = 0.004) calyces. Interpolar calyceal pressure in the presence of a UAS was significantly higher than the renal pelvis pressure (RPP) (30.8 ± 19.6 vs. 17.9 ± 11.0 mmHg, p = 0.004).

Conclusions

During flexible URS, RPP strongly correlates with, but does not uniformly represent, the intracalyceal pressure. With a 14/16Fr UAS and an inflow pressure of 150 mmHg, RPP and intracalyceal pressure never exceed the threshold for renal backflow.

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Acknowledgements

This work was partially supported by grant UL1 TR001414 from the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through the Biostatistics, Epidemiology and Research Design Unit. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funding

This study did not receive any external sources of funding.

Author information

Authors and Affiliations

  1. Department of Urology, University of California, 333 City Blvd. West, Suite 2100, Irvine, Orange, CA, 92868, USA

    Roshan M. Patel, Francis A. Jefferson, Michael Owyong, Martin Hofmann, Maged L. Ayad, Kathryn Osann, Zhamshid Okhunov, Jaime Landman & Ralph V. Clayman

Authors
  1. Roshan M. Patel
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  2. Francis A. Jefferson
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  3. Michael Owyong
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  4. Martin Hofmann
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  5. Maged L. Ayad
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  6. Kathryn Osann
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  7. Zhamshid Okhunov
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  8. Jaime Landman
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  9. Ralph V. Clayman
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Contributions

RMP: protocol/project development, data collection, data analysis, manuscript writing/editing. FAJ: data collection, data analysis, manuscript writing/editing. MO: protocol/project development, data collection, data analysis. MH: data collection, data analysis, manuscript editing. MLA: data collection, data analysis. Osann: data analysis. KO: protocol/project development, data collection. JL: protocol/project development, data collection. RVC: protocol/project development, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Roshan M. Patel.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of California, Irvine institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Patel, R.M., Jefferson, F.A., Owyong, M. et al. Characterization of intracalyceal pressure during ureteroscopy. World J Urol 39, 883–889 (2021). https://doi.org/10.1007/s00345-020-03259-z

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  • DOI: https://doi.org/10.1007/s00345-020-03259-z

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