Skip to main content
SpringerLink
Log in

Fluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate?

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of ureteroscope position within renal cavities as well as different locations of the tip of the ureteral access sheath (UAS) on fluid dynamics during retrograde intrarenal surgery (RIRS).

Materials and methods

A prospective observational clinical study was performed. Measurements with a flexible ureteroscope placed in the upper, middle and lower calyces were obtained with the tip of the UAS placed either 2 cm below the pyelo-ureteric junction (PUJ), or at the level of the iliac crest.

Results

74 patients were included. The outflow rates from the middle and upper calyxes were statistically significantly higher compared to the lower calyx, both with the UAS close to the pyelo-ureteric junction and at the iliac crest. When the UAS was withdrawn and positioned at the level of the iliac crest, a significant decrease in outflow rates from the upper (40.1 ± 4.3 ml/min vs 35.8 ± 4.1 ml/min) and middle calyces (40.6 ± 4.0 ml/min vs 36.8 ± 4.6 ml/min) and an increase in the outflow from the lower calyx (28.5 ± 3.3 ml/min vs 33.7 ± 5.7 ml/min) were noted.

Conclusions

Our study showed that higher fluid outflow rates are observed from upper and middle calyces compared to lower calyx. This was true when the UAS was positioned 2 cm below the PUJ and at the iliac crest. Significant worsening of fluid dynamics from upper and middle calyces was observed when the UAS was placed distally at the level of the iliac crest. While the difference was statistically significant, the absolute change was not significant. In contrast, for lower calyces, a statistically significant improvement was documented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The data cannot be shared publically.

References

  1. Noureldin YA, Kallidonis P, Liatsikos EN (2020) Lasers for stone treatment: how safe are they? Curr Opin Urol 30(2):130–134. https://doi.org/10.1097/MOU.0000000000000706

    Article  PubMed  Google Scholar 

  2. Rassweiler J, Rassweiler MC, Klein J (2016) New technology in ureteroscopy and percutaneous nephrolithotomy. Curr Opin Urol 26(1):95–106. https://doi.org/10.1097/MOU.0000000000000240

    Article  PubMed  Google Scholar 

  3. Chung JH, Baek M, Park SS, Han DH (2021) The feasibility of pop-dusting using high-power laser (2 J x 50 Hz) in retrograde intrarenal surgery for renal stones: retrospective single-center experience. J Endourol 35(3):279–284. https://doi.org/10.1089/end.2020.0585

    Article  PubMed  Google Scholar 

  4. Tracey J, Gagin G, Morhardt D, Hollingsworth J, Ghani KR (2018) Ureteroscopic high-frequency dusting utilizing a 120-W holmium laser. J Endourol 32(4):290–295. https://doi.org/10.1089/end.2017.0220

    Article  PubMed  Google Scholar 

  5. Tsaturyan A, Ballesta Martinez B, Lattarulo M, Adamou C, Pagonis K, Peteinaris A, Liourdi D, Vrettos T, Liatsikos EN, Kallidonis P (2022) Could the high-power laser increase the efficacy of stone lithotripsy during retrograde intrarenal surgery? J Endourol. https://doi.org/10.1089/end.2021.0870

    Article  PubMed  Google Scholar 

  6. Wollin DA, Carlos EC, Tom WR, Simmons WN, Preminger GM, Lipkin ME (2018) Effect of laser settings and irrigation rates on ureteral temperature during holmium laser lithotripsy, an in vitro model. J Endourol 32(1):59–63. https://doi.org/10.1089/end.2017.0658

    Article  PubMed  Google Scholar 

  7. Peteinaris A, Pagonis K, Vagionis A, Adamou C, Tsaturyan A, Ballesta Martinez B, Karpetas G, Farsari E, Liatsikos E, Kallidonis P (2022) What is the impact of pulse modulation technology, laser settings and intraoperative irrigation conditions on the irrigation fluid temperature during flexible ureteroscopy? An in vivo experiment using artificial stones. World J Urol. https://doi.org/10.1007/s00345-022-04002-6

    Article  PubMed  PubMed Central  Google Scholar 

  8. Noureldin YA, Farsari E, Ntasiotis P, Adamou C, Vagionis A, Vrettos T, Liatsikos EN, Kallidonis P (2021) Effects of irrigation parameters and access sheath size on the intra-renal temperature during flexible ureteroscopy with a high-power laser. World J Urol 39(4):1257–1262. https://doi.org/10.1007/s00345-020-03287-9

    Article  CAS  PubMed  Google Scholar 

  9. Molina WR, Carrera RV, Chew BH, Knudsen BE (2021) Temperature rise during ureteral laser lithotripsy: comparison of super pulse thulium fiber laser (SPTF) vs high power 120 W holmium-YAG laser (Ho:YAG). World J Urol 39(10):3951–3956. https://doi.org/10.1007/s00345-021-03619-3

    Article  CAS  PubMed  Google Scholar 

  10. De Coninck V, Defraigne C, Traxer O (2022) Watt determines the temperature during laser lithotripsy. World J Urol 40(5):1257–1258. https://doi.org/10.1007/s00345-021-03848-6

    Article  PubMed  Google Scholar 

  11. Tsaturyan A, Peteinaris A, Pantazis L, Farsari E, Pagonis K, Adamou C, Vagionis A, Natsos A, Liatsikos E, Kallidonis P (2022) The effect of prolonged laser activation on irrigation fluid temperature: an in vitro experimental study. World J Urol. https://doi.org/10.1007/s00345-022-04000-8

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tokas T, Herrmann TRW, Skolarikos A, Nagele U, Training, Research in Urological S, Technology G (2019) Pressure matters: intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology. World J Urol 37(1):125–131. https://doi.org/10.1007/s00345-018-2378-4

    Article  PubMed  Google Scholar 

  13. Doizi S, Letendre J, Cloutier J, Ploumidis A, Traxer O (2021) Continuous monitoring of intrapelvic pressure during flexible ureteroscopy using a sensor wire: a pilot study. World J Urol 39(2):555–561. https://doi.org/10.1007/s00345-020-03216-w

    Article  PubMed  Google Scholar 

  14. De Coninck V, Keller EX, Rodriguez-Monsalve M, Audouin M, Doizi S, Traxer O (2018) Systematic review of ureteral access sheaths: facts and myths. BJU Int 122(6):959–969. https://doi.org/10.1111/bju.14389

    Article  PubMed  Google Scholar 

  15. De Coninck V, Somani B, Sener ET, Emiliani E, Corrales M, Juliebo-Jones P, Pietropaolo A, Mykoniatis I, Zeeshan Hameed BM, Esperto F, Proietti S, Traxer O, Keller EX (2022) Ureteral access sheaths and its use in the future: a comprehensive update based on a literature review. J Clin Med. https://doi.org/10.3390/jcm11175128

    Article  PubMed  PubMed Central  Google Scholar 

  16. Patel RM, Jefferson FA, Owyong M, Hofmann M, Ayad ML, Osann K, Okhunov Z, Landman J, Clayman RV (2021) Characterization of intracalyceal pressure during ureteroscopy. World J Urol 39(3):883–889. https://doi.org/10.1007/s00345-020-03259-z

    Article  PubMed  Google Scholar 

  17. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580–584. https://doi.org/10.1016/j.juro.2012.08.197

    Article  PubMed  Google Scholar 

  18. Faria-Costa G, Tsaturyan A, Peteinaris A, Faitatziadis S, Liatsikos E, Kallidonis P (2022) Determinants of outflow rate through the ureteral access sheath during flexible ureteroscopy: an experimental in vivo study in an anesthetized porcine model. Urolithiasis 51(1):18. https://doi.org/10.1007/s00240-022-01377-4

    Article  PubMed  Google Scholar 

  19. Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, Srinivas R, Sundaram CP, Clayman RV (2003) Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology 61(4):713–718. https://doi.org/10.1016/s0090-4295(02)02440-8

    Article  PubMed  Google Scholar 

  20. Ng YH, Somani BK, Dennison A, Kata SG, Nabi G, Brown S (2010) Irrigant flow and intrarenal pressure during flexible ureteroscopy: the effect of different access sheaths, working channel instruments, and hydrostatic pressure. J Endourol 24(12):1915–1920. https://doi.org/10.1089/end.2010.0188

    Article  PubMed  Google Scholar 

  21. Noureldin YA, Kallidonis P, Ntasiotis P, Adamou C, Zazas E, Liatsikos EN (2019) The effect of irrigation power and ureteral access sheath diameter on the maximal intra-pelvic pressure during ureteroscopy: in vivo experimental study in a live anesthetized pig. J Endourol 33(9):725–729. https://doi.org/10.1089/end.2019.0317

    Article  PubMed  Google Scholar 

  22. Fang L, Xie G, Zheng Z, Liu W, Zhu J, Huang T, Lu Y, Cheng Y (2019) The effect of ratio of endoscope-sheath diameter on intrapelvic pressure during flexible ureteroscopic lasertripsy. J Endourol 33(2):132–139. https://doi.org/10.1089/end.2018.0774

    Article  PubMed  Google Scholar 

  23. Solano C, Chicaud M, Kutchukian S, Candela L, Corrales M, Panthier F, Doizi S, Traxer O (2023) Optimizing Outcomes in flexible ureteroscopy: a narrative review of suction techniques. J Clin Med. https://doi.org/10.3390/jcm12082815

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Not applicable.

Author information

Author notes

  1. Arman Tsaturyan and Etienne X. Keller have contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Erebouni Medical Center, 0087, Yerevan, Armenia

    Arman Tsaturyan

  2. EAU Young Academic Urologists (YAU) Urolithiasis and Endourology Working Group Arnhem, NL-6803, Arnhem, The Netherlands

    Arman Tsaturyan, Etienne X. Keller, Amelia Pietropaolo, Eugenio Ventimiglia, Francesco Esperto, Tarik Emre Sener, Vincent De Coninck, Esteban Emiliani, B. M. Zeeshan Hameed, Michele Talso, Ioannis Mykoniatis & Lazaros Tzelves

  3. Department of Urology, University Hospital Zurich, University of Zurich, 8006, Zurich, Switzerland

    Etienne X. Keller

  4. Department of Urology, University of Patras, 26504, Patras, Greece

    Angelis Peteinaris, Vaseilios Tatanis & Panagiotis Kallidonis

  5. Department of Urology, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal

    Faria-Costa Gabriel

  6. Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal

    Faria-Costa Gabriel

  7. Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK

    Amelia Pietropaolo

  8. Department of Urology, University Hospital del Vinalopo, Alicante, Spain

    Begona Ballesta Martinez

  9. Division of Experimental Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy

    Eugenio Ventimiglia

  10. School of Medicine, Vita-Salute San Raffaele University, 20132, Milan, Italy

    Eugenio Ventimiglia

  11. Department of Urology, Campus Biomedico University of Rome, 00128, Rome, Italy

    Francesco Esperto

  12. Department of Urology, Marmara University School of Medicine, 34854, Istanbul, Turkey

    Tarik Emre Sener

  13. Department of Urology, AZ Klina, 2930, Brasschaat, Belgium

    Vincent De Coninck

  14. Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08193, Barcelona, Spain

    Esteban Emiliani

  15. Department of Urology, Father Muller Medical College, Mangalore, Karnataka, 575002, India

    B. M. Zeeshan Hameed

  16. Department of Urology, ASST Fatebenefratelli Sacco, Luigi Sacco University Hospital, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy

    Michele Talso

  17. Department of Urology, Aristotle University of Thessaloniki, 541 24, Thessaloniki, Greece

    Ioannis Mykoniatis

  18. Institute of Urology, University College Hospital London, London, NW1 2BU, UK

    Lazaros Tzelves

Authors
  1. Arman Tsaturyan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Etienne X. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angelis Peteinaris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faria-Costa Gabriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Amelia Pietropaolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Begona Ballesta Martinez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vaseilios Tatanis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eugenio Ventimiglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francesco Esperto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tarik Emre Sener
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Vincent De Coninck
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Esteban Emiliani
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. B. M. Zeeshan Hameed
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Michele Talso
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ioannis Mykoniatis
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Lazaros Tzelves
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Panagiotis Kallidonis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Arman Tsaturyan—study design and conception, data analysis, interpretation of data and critical revision. Etienne X Keller—data analysis, interpretation of data, critical revision and manuscript editing. Angelis Peteinaris—data analysis, manuscript drafting. Faria-Costa Gabriel—data analysis, manuscript drafting. Amelia Pietropaolo—critical revision. Begona Ballesta Martinez—study conception and critical revision. Vaseilios Tatanis—critical revision. Eugenio Ventimiglia—critical revision. Francesco Esperto—critical revision. Emre Sener—critical revision. Vincent De Coninck—critical revision. Esteban Emiliani—critical revision. B M Zeeshan Hameed—critical revision. Michele Talso—critical revision. Ioannis Mykoniatis—critical revision. Lazaros Tzelves—critical revision. Panagiotis Kallidonis—study design and conception, interpretation of data and critical revision.

Corresponding author

Correspondence to Arman Tsaturyan.

Ethics declarations

Conflict of interest

The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Ethical approval

The study has been carried out in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

Written consent was obtained from each patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsaturyan, A., Keller, E.X., Peteinaris, A. et al. Fluid dynamics within renal cavities during endoscopic stone surgery: does the position of the flexible ureteroscope and ureteral access sheath affect the outflow rate?. World J Urol 42, 240 (2024). https://doi.org/10.1007/s00345-024-04926-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00345-024-04926-1

Keywords

Search

Navigation