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Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology

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Abstract

Purpose

To perform a review on the latest evidence related to normal and pathological intrarenal pressures (IRPs), complications of incremented values, and IRP ranges during endourology.

Methods

A literature search was performed using PubMed, restricted to original English-written articles, including animal, artificial model, and human studies. Different keywords were: percutaneous nephrolithotomy, PCNL, ureteroscopy, URS, RIRS, irrigation flow, irrigation pressure, intrarenal pressure, intrapelvic pressure and renal pelvic pressure.

Results

Normal IRPs range from zero to a few cm H2O. Pyelovenous backflow may occur at pressure range of 13.6–27.2 cm H2O. During upper tract endourology, complications such as pyelorenal backflow, sepsis, and renal damage are directly related to increased IRPs. Duration of increased IRPs and concomitant obstruction are independent predictors of complication development.

Conclusions

IRP increase remains a neglected predictor of upper tract endourology complications and its intraoperative monitoring should be taken into consideration. Further research is necessary, to quantify pressures generated during upper tract endourology, and introduce means of controlling them.

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Authors and Affiliations

  1. Department of Urology and Andrology, General Hospital Hall in Tirol, Milser Str. 10, 6060, Hall in Tirol, Austria

    Theodoros Tokas & Udo Nagele

  2. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  3. Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece

    Andreas Skolarikos

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  1. Theodoros Tokas
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  2. Thomas R. W. Herrmann
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  3. Andreas Skolarikos
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  4. Udo Nagele
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Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

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TT: Data management, data analysis, manuscript writing. TRW Herrmann: Interpreting data. AS: Interpreting data. UN: Protocol/project development and interpreting data.

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Correspondence to Theodoros Tokas.

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Tokas, T., Herrmann, T.R.W., Skolarikos, A. et al. Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 37, 125–131 (2019). https://doi.org/10.1007/s00345-018-2378-4

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  • DOI: https://doi.org/10.1007/s00345-018-2378-4

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