Monitoring of intrarenal pressure during ureteroscopic lithotripsy

Abstract

To investigate the changes of intrarenal pressure in response to continuous irrigation at different pressures during ureteroscopic lithotripsy. Eleven patients with residual ureteral calculi after percutaneous nephrolithotomy (PCNL), 8 in the proximal section, 2 in the middle section, 1 in the distal section. And one patient with calculi in the distal ureteral section underwent ureteroscopic lithotripsy. Renal fistula tube was connected with a urine dynamic detector and irrigation was performed continuously through the ureteroscope at different pressures. The baseline intra-pelvic pressure (IPP(0)) and maximum intra-pelvic pressure (IPP(max)) were recorded. The average IPP(0) was (16.9 +/- 3.2) cm H(2)O. The IPP levels during the ureteroscopic lithotripsy [(172.6 +/- 32.2) cm H(2)O] were all significantly higher than the IPP(0) (all P < 0.01). In response to the irrigation pump pressure of 100 mmHg, the IPP(max) during the ureteroscopic lithotripsy in the distal, middle, and proximal ureter were 74.6, 93.5, and (110.3 +/- 2.4) cm H(2)O respectively. When the irrigation pump pressure levels were 50, 100, and 200 mm Hg respectively the IPP(max) levels during the ureteroscopic lithotripsy in the proximal ureter were (51.0 +/- 4.5), (110.3 +/- 2.4), and (193.2 +/- 5.9) cm H(2)O respectively (all P < 0.01). The renal pelvic pressure is significantly increased during ureteroscopic lithotripsy. High renal pelvic pressure is associated with the irrigation pressure and the position of calculi.