Skip to main content
SpringerLink
Log in

The effect and safety assessment of monitoring ethanol concentration in exhaled breath combined with intelligent control of renal pelvic pressure on the absorption of perfusion fluid during flexible ureteroscopic lithotripsy

  • Urology - Original Paper
  • Published:
International Urology and Nephrology Aims and scope Submit manuscript

Abstract

Purpose

Previously, we designed a ureteral access sheath with the capability of renal pelvic pressure (RPP) measurement and a medical perfusion and aspiration platform, allowing for the intelligent control of RPP. However, the effect of different RPP levels on perfusion fluid absorption remains unclear. This randomized controlled trial aimed to investigate the effects of exhaled ethanol concentration monitoring and intelligent pressure control on perfusion fluid absorption during flexible ureteroscopic lithotripsy.

Methods

Eighty patients scheduled for flexible ureteroscopic lithotripsy were randomly divided into four groups. In groups A, B, and C, the RPPs were set at 0, − 5, and − 10 mmHg, respectively. Group D was regarded as the controls with unfixed RPP. Isotonic saline containing 1% ethanol was used as the irrigation fluid, with an average irrigation flow rate of 100 mL/min. The primary outcome of this study was the absorption of perfusion fluid that was calculated based on the exhaled ethanol concentration. The secondary outcomes included duration of operation and amounts of perfusion fluid used. Postoperative complications, pre- and postoperative renal function, infection markers, and blood gas analysis were also recorded for safety assessment.

Results

In all, 76 patients were involved in this study, whose demographic characteristics and preoperative conditions were comparable among groups. Under the same perfusion flow rate, the groups with fixed RPP exhibited reduced absorption of perfusion fluid, duration of operation, and perfusion volume. In particular, the lowest values were observed in group C (RPP =  − 10 mmHg). In contrast to the unfixed RPP group, no considerable difference were observed in levels of BUN, Scr, WBC, CRP, and blood gas values among the fixed RPP groups. Moreover, postoperative complications showed no significant difference among groups.

Conclusion

In flexible ureteroscopic lithotripsy, the groups with fixed RPP had less absorption of perfusion fluid and perfusion volume, shorter duration of surgery, and higher safety than the unfixed group.

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

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Wang Z, Zhang Y, Zhang J, Deng Q, Liang H (2021) Recent advances on the mechanisms of kidney stone formation (Review). Int J Mol Med 48(2)

  2. Young JG (2018) Urinary tract stones in cystic fibrosis. Paediatr Respir Rev 27:21–23

    PubMed  Google Scholar 

  3. Tiselius HG, Chaussy CG (2015) Arguments for choosing extracorporeal shockwave lithotripsy for removal of urinary tract stones. Urolithiasis 43(5):387–396

    Article  PubMed  Google Scholar 

  4. Wickham JE (1993) Treatment of urinary tract stones. BMJ 307(6916):1414–1417

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Wang Q, Guo J, Hu H, Lu Y, Zhang J, Qin B et al (2017) Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: a meta-analysis. PLoS ONE 12(2):e0171478

    Article  PubMed  PubMed Central  Google Scholar 

  6. Jiang JT, Li WG, Zhu YP, Sun WL, Zhao W, Ruan Y et al (2016) Comparison of the clinical efficacy and safety of retroperitoneal laparoscopic ureterolithotomy and ureteroscopic holmium laser lithotripsy in the treatment of obstructive upper ureteral calculi with concurrent urinary tract infections. Lasers Med Sci 31(5):915–920

    Article  PubMed  Google Scholar 

  7. Fam XI, Singam P, Ho CC, Sridharan R, Hod R, Bahadzor B et al (2015) Ureteral stricture formation after ureteroscope treatment of impacted calculi: a prospective study. Korean J Urol 56(1):63–67

    Article  PubMed  PubMed Central  Google Scholar 

  8. Barbour ML, Raman JD (2015) Incidence and predictors for ipsilateral hydronephrosis following ureteroscopic lithotripsy. Urology 86(3):465–471

    Article  PubMed  Google Scholar 

  9. Tokas T, Herrmann TRW, Skolarikos A, Nagele U (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

    Article  PubMed  Google Scholar 

  10. Kang D, Qigui L, Yueli W, Fulin X, Xinyuan Z, Juan D et al (2016) Technique and clinical significance of intrarenal pressure monitoring during flexible ureteroscopic lithotripsy (a report of 13 cases). Med J Natl Defend Forces Southwest China 26(02):126–129.

  11. Jakobsen JS (2013) Endoluminal pharmacologic stimulation of the upper urinary tract. Dan Med J 60(5):B4642

    PubMed  Google Scholar 

  12. Liang H, Liang L, Yu Y, Huang B, Chen J, Wang C et al (2020) Thermal effect of holmium laser during ureteroscopic lithotripsy. BMC Urol 20(1):69

    Article  PubMed  PubMed Central  Google Scholar 

  13. Deng X, Xie D, Huang X, Huang J, Song L, Du C (2022) Suctioning flexible ureteroscopy with automatic control of renal pelvic pressure versus mini PCNL for the treatment of 2-3-cm kidney stones in patients with a solitary kidney. Urol Int 106(12):1293–1297

    Article  CAS  PubMed  Google Scholar 

  14. Du C, Song L, Wu X, Deng X, Yang Z, Zhu X et al (2019) A study on the clinical application of a patented perfusion and suctioning platform and ureteral access sheath in the treatment of large ureteral stones below L4 level. Int Urol Nephrol 51(2):207–213

    Article  CAS  PubMed  Google Scholar 

  15. Deng X, Xie D, Du C, Song L, Huang J, Tan W (2019) A novel technique to intelligently monitor and control renal pelvic pressure during minimally invasive percutaneous nephrolithotomy. Urol Int 103(3):331–336

    Article  PubMed  Google Scholar 

  16. Zhu X, Song L, Xie D, Peng Z, Guo S, Deng X et al (2016) Animal experimental study to test application of intelligent pressure control device in monitoring and control of renal pelvic pressure during flexible ureteroscopy. Urology 91(242):e11–e15

    Google Scholar 

  17. Deng X, Song L, Xie D, Fan D, Zhu L, Yao L et al (2016) A novel flexible ureteroscopy with intelligent control of renal pelvic pressure: an initial experience of 93 cases. J Endourol 30(10):1067–1072

    Article  PubMed  Google Scholar 

  18. Hahn RG (2015) Fluid absorption and the ethanol monitoring method. Acta Anaesthesiol Scand 59(9):1081–1093

    Article  CAS  PubMed  Google Scholar 

  19. Zhou XD, Li C, Chen-Ran L (2021) Effects of flexible ureteroscope lithotripsy under different conditions of renal pelvic pressure on pain stress response and vascular endothelial injury in patients with renal stones. J Hunan Normal Univ (Med Sci) 18(06):24–27

  20. Holst U, Dissing T, Rawashdeh YF, Frokiaer J, Djurhuus JC, Mortensen J (2003) Norepinephrine inhibits the pelvic pressure increase in response to flow perfusion. J Urol 170(1):268–271

    Article  CAS  PubMed  Google Scholar 

  21. Bin H, Bao-xing L, Jiu-kai W, Zhen-quan L, Wen-hong L (2010) Monitoring the irrigating fluid absorption during percutaneous nephrolithotomy by ethanol method. Chin J Urol 31(12):818–821

    Google Scholar 

  22. Guzelburc V, Balasar M, Colakogullari M, Guven S, Kandemir A, Ozturk A et al (2016) Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm. Springerplus 5(1):1707

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kottooran C, Twum-Ampofo J, Lee J, Saunders J, Franco M, Budrewicz J et al (2023) Evaluation of fluid absorption during flexible ureteroscopy in an in vivo porcine model. BJU Int 131(2):213–218

    Article  PubMed  Google Scholar 

  24. Porsch M, Mittelstädt P, Wendler JJ, Baumunk D, Fichtler K, Janitzky A et al (2016) Measurement of procedure-specific irrigation-fluid absorption in transurethral therapy of lower urinary tract syndrome, using ethanolic saline and breath alcometry. Urol Int 97(3):299–309

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

This research was funded by the Jiangxi Provincial Science and Technology Agency Key R&D Plan (General Project), Grant Number 20202BBGL73089.

Author information

Authors and Affiliations

  1. Department of Anaesthesiology, Ganzhou People’s Hospital, Ganzhou, 341000, Jiangxi, China

    Yi-Jian Chen, Shi-Wen Liu, Yi-Sheng Huang, Wen Zhou & Hong-Biao Yang

  2. Department of Urology, Ganzhou People’s Hospital, Ganzhou, 341000, Jiangxi, China

    Xiao-Lin Deng

  3. Special Needs Medical Unit, Ganzhou People’s Hospital, Ganzhou, 341000, Jiangxi, China

    Jie-Xian Liang

Authors
  1. Yi-Jian Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shi-Wen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao-Lin Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jie-Xian Liang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yi-Sheng Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hong-Biao Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CYJ designed the study; LSW, DXL, LJX, and HYS collected data and materials; ZW and YHB analyzed the collected data; CYJ wrote the manuscript. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Yi-Jian Chen.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical statement

This study was approved by the Ethics Committee of the Ganzhou People's Hospital (TY-ZKY2021-005-01).

Consent for publication

Not Applicable.

Consent to participate

Informed consent was obtained from all patients participating.

Additional information

Publisher's Note

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

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 799 KB)

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

Chen, YJ., Liu, SW., Deng, XL. et al. The effect and safety assessment of monitoring ethanol concentration in exhaled breath combined with intelligent control of renal pelvic pressure on the absorption of perfusion fluid during flexible ureteroscopic lithotripsy. Int Urol Nephrol 56, 45–53 (2024). https://doi.org/10.1007/s11255-023-03776-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11255-023-03776-x

Keywords

Search

Navigation