Abstract
Miniaturization of ureteroscopy materials is intended to decrease tissue damage. However, tissue hypoxia and the gross and microscopic effects on tissue have not been adequately assessed. We compared the gross and microscopic effects of micro-ureteroscopy (m-URS) and conventional ureteroscopy (URS) on the urinary tract. We employed 14 pigs of the Large White race. URS was performed in one of the ureters with an 8/9.8 F ureteroscope, while a 4.85 F m-URS sheath was used in the contralateral ureter. Gross assessment of ureteral wall damage and ureteral orifice damage was performed. For microscopic assessment hematoxylin-eosin staining and immunohistochemistry for detection of tissue hypoxia were conducted. Regarding the macroscopic assessment of ureteral damage, substantial and significant differences were recorded using URS (C = 0.8), but not with m-URS. Microscopic assessment after staining with hematoxylin-eosin revealed greater epithelial desquamation in the URS group (p < 0.05). Pimonidazole staining revealed greater hypoxia in the epithelial cells than in the remainder of the ureteral layers. We conclude that m-URS causes less damage to the ureteral orifice than URS. Histopathological findings show m-URS reduces ureteral epithelial damage compared with conventional ureteroscopy. Both URS and m-URS cause cellular hypoxia.
Highlights
As a result of technological advances in ureteroscopes, imaging systems and ancillary devices, ureteroscopy has become one of the fundamental techniques used in endourology[1]
No differences between the baseline and final conditions of the ureteral orifice (UO) were observed with m-URS (C = 0.2)
Routine postoperative stenting is no longer recommended, a multicenter study demonstrated that, after 4475 ureteroscopies performed to treat distal ureteral stones, a double J stent was placed in 54.7% of patients[7]
Summary
As a result of technological advances in ureteroscopes, imaging systems and ancillary devices, ureteroscopy has become one of the fundamental techniques used in endourology[1]. Damage to the ureteral wall has been associated with complications such as hematuria, postoperative edema or renoureteral colic. To further reduce ureteroscope caliber, micro-ureteroscopy (m-URS) was first described in 2014 as a ureteroscope using a 4.85 F (French) sheath of the micropercutaneous surgery set for the treatment of distal ureteral lithiasis in women, with satisfactory results[4,5]. No comparative studies reporting scientific evidence at the micro- or macroscopic level of the ureteral effects of ureteroscopes of different calibers have been published. ® was to determine whether micro-ureteroscopy performed with the 4.85 F access sheath of the micro-Perc set (Polydiagnost, Germany) produces fewer adverse effects compared with a conventional 8/9.8 F ureteroscope, www.nature.com/scientificreports/
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