Abstract
Ureteroscopy is an endoscopic kidney stone removal procedure which increases the internal pressure in the renal pelvis, the kidney’s urinary collecting system. Elevated renal pelvic pressure may result in systemic absorption of irrigation fluid and urine, which can increase the risk of postoperative fever and sepsis. Urologists have investigated the effects of various surgical parameters on the renal pelvic pressure. However, it still remains unknown which surgical parameter has the most dominant effect on the renal pelvic pressure over time. Here we develop a physical model that computes the renal pelvic pressure as a function of time based on parameters that can be varied during ureteroscopy. The model is developed by applying pipe network analysis to the regions of the urinary tract that are involved in a representative ureteroscopic procedure. Our model unifies the findings of the previously published studies on this topic; an ex-vivo porcine study and an in-vivo human study. Furthermore it allows simulation of surgical procedures based on various techniques. Our simulation demonstrates that the two strong regulators of renal pelvis pressure during ureteroscopy are the size of the gap between ureteroscope and ureteral access sheath and the frequency and duration of ureteroscope withdrawal.
Highlights
Nephrolithiasis is a common disease and affecting approximately one in every ten people in the United States [1]
It has long been postulated that urosepsis after ureteroscopy occurs due to pyelovenous backflow of bacteria in the urine or harbored within a stone that is fragmented
Pyelovenous backflow was first described in 1856 by Gigon while evaluating kidney specimens and was further explored in the 1920s by Hinman, Lee-Brown, and Laidley, who noted the phenomenon of pyelovenous backflow across animal species and ex-vivo human kidneys [2,3,4]
Summary
Nephrolithiasis is a common disease and affecting approximately one in every ten people in the United States [1]. One of the most common treatments for ureteral and renal stones is ureteroscopic lithotripsy—the use of this treatment modality is increasing and is used for more than 10% of all persons with an acute stone episode. Elevated renal pelvis pressures during ureteroscopic lithotripsy are a risk factor for retrograde flow of urine into the bloodstream via pyelovenous backflow [2,3,4]. If the urine contains bacteria, this backflow can result in life threatening bacterial infection of the bloodstream [5].
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