Abstract
Introduction
High irrigation rates are commonly used during ureteroscopy and can increase intrarenal pressure (IRP) substantially. Concerns have been raised that elevated IRP may diminish renal blood flow (RBF) and perfusion of the kidney. Our objective was to investigate the real-time changes in RBF while increasing IRP during Ureteroscopy (URS) in an in-vivo porcine model.
Methods
Four renal units in two porcine subjects were used in this study, three experimental units and one control. For the experimental units, RBF was measured by placing an ultrasonic flow cuff around the renal artery, while performing ureteroscopy in the same kidney using a prototype ureteroscope with a pressure sensor at its tip. Irrigation was cycled between two rates to achieve targeted IRPs of 30 mmHg and 100 mmHg. A control data set was obtained by placing the ultrasonic flow cuff on the contralateral renal artery while performing ipsilateral URS.
Results
At high IRP, RBF was reduced in all three experimental trials by 10–20% but not in the control trial. The percentage change in RBF due to alteration in IRP was internally consistent in each porcine renal unit and independent of slower systemic variation in RBF encountered in both the experimental and control units.
Conclusion
RBF decreased 10–20% when IRP was increased from 30 to 100 mmHg during ureteroscopy in an in-vivo porcine model. While this reduction in RBF is unlikely to have an appreciable effect on tissue oxygenation, it may impact heat-sink capacity in vulnerable regions of the kidney.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors would like to acknowledge Professor J. Brian Fowlkes for loaning us the transonic flow measurement system.
Funding
Funding for this research was provided through a research grant from Boston Scientific.
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RM: project development, data collection, manuscript writing, and data analysis. WWR: manuscript writing/editing, data analysis, critical revision, and study management. JJD: manuscript editing. KRG: manuscript editing. TLH: manuscript editing.
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K.R.G. has consulting relationships with Boston Scientific, Ambu, Olympus, Coloplast, and Karl Storz. W.W.R. has a consulting relationship with Boston Scientific. R.M., J.J.D., and T.L.H. have no disclosures. The prototype ureteroscope used in this study was a concept device/technology, which was not available for sale at the time the study was conducted. Pre-clinical study results may not necessarily be indicative of clinical performance.
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All procedures performed in the study involving animal subjects were in accordance with the ethical standards of the institutional research committee and were approved by the University of Michigan’s Institutional Animal Care and Use Committee (IACUC).
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Marom, R., Dau, J.J., Ghani, K.R. et al. Change in renal blood flow in response to intrarenal pressure alterations induced by ureteroscopy in an in-vivo porcine model. World J Urol 41, 3181–3185 (2023). https://doi.org/10.1007/s00345-023-04641-3
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DOI: https://doi.org/10.1007/s00345-023-04641-3