Pelvic Pressure Research Articles

Coaxial robot-assisted laparoendoscopic single-site myomectomy.

We report our experience with coaxial robot-assisted laparoendoscopic single-site (RA-LESS) myomectomy, including a detailed description of the technique and outcomes from our first 21 cases. This was a retrospective cohort study carried out at the reproductive endocrinology and gynecologic oncology divisions at two academic medical centers. RA-LESS myomectomy was performed with the da Vinci Si Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA, USA) employing standard rigid 8 or 5mm instrumentation in a coaxial arrangement through a standard laparoendoscopic single-site (LESS) port (GelPOINT Advanced Access Platform, Applied Medical, Rancho Santa Margarita, CA, USA). Cases were completed between October 2011 and November 2013. Twenty-one patients underwent surgery. Mean age (±SD) was 38.1±5.8years, and mean BMI was 29.4±4.7kg/m2. Menorrhagia, pelvic pressure, and urinary frequency were the main presenting symptoms. Mean diameter of the largest tumor was 5.7±1.9cm (median 5.9cm, range 2.1-9.5cm), while mean number of tumors removed was 2.2±1.8, ranging from 1 to 8 per surgery. Mean operative time was 154.2±55.2min (median 152min, range 85-290min). Mean blood loss was 57.9±53.7cc (median 50cc, range 5-200cc) and length of hospital stay ranged between 0 and 3days (median 0). All procedures were successfully performed without conversion to conventional LESS surgery, multi-port laparoscopy or laparotomy. RA-LESS myomectomy with coaxial use of standard rigid instrumentation is a safe and reproducible addition to the minimally invasive surgeons' armamentarium, with excellent cosmetic and postoperative outcomes in selected patients. Further investigation is needed to define the patient groups that will most benefit from it.

Verapamil Inhibits the Pelvic Pressure Increase Corresponding to Flow Perfusion in the Porcine Percutaneous Renal Puncture Model

Purpose: To estimate the effects of verapamil on pelvic pressure and investigate the possible systemic side effects in the porcine model during the procedure of increasing perfusion rates. Materials and Methods: In the experimental group, the pelvic pressure was recorded with increasing perfusion rates of the renal pelvis (0, 2, 4, 6, 8, 10, 14 and 20 ml/min) in response to intraluminal administration of increasing concentrations of verapamil (0, 0.1, 1, 10 and 100 µg/ml) in isotonic saline. In the isotonic saline group, the pressure flow study was also done by increasing perfusion rates of the renal pelvis per animal using isotonic saline without verapamil. Results: Perfusion with 1, 10 and 100 µg/ml verapamil caused a decrease in pelvic pressure as a response to increasing flow rates, whereas perfusion with 0.1 µg/ml verapamil did not obviously inhibit the increase of pelvic pressure at all perfusion rates compared with other concentrations. Importantly, the mean systolic blood pressure and mean heart rate were stable despite the increase of flow rates and verapamil concentrations. In the isotonic saline group, perfusion with isotonic saline resulted in an increase in the pelvic pressure with an increase in flow rates each time. Conclusions: Endoluminal administration of verapamil reduces pelvic pressure significantly without any untoward systemic cardiovascular side effects.

Identification of Renal Pelvic Sodium Channel Input to the Brain Stem and Hypothalamus in the Rat

There is considerable evidence that elevated central sympathetic nerve activity contributes to the development of essential hypertension. It has been suggested that renal afferent nerves facilitate the increase in central sympathetic drive. Renal afferent projections to the CNS have been mapped using tract tracing techniques (e.g., pseudorabies virus) and electrical stimulation (c‐fos activation) demonstrating a number of regions that receive renal sensory input but not discriminating between chemo and mechanoreceptor afferents. Since renal sensory neurons are highly concentrated in the renal pelvis, we sought to identify the central projections of renal pelvic afferent nerves sensitive to hypertonic saline. We hypothesized that hypertonic saline would activate renal pelvic epithelial sodium channel (ENaC) projections to key autonomic areas of the CNS involved in blood pressure control.We implanted a triple lumen cannula into the left renal pelvis of rats and catheterized the femoral artery to measure arterial pressure and heart rate. After recovery, the left kidney continued to function voiding urine. Five days later, the renal pelvis was flushed in a push‐pull manner (40–60 μl/min) while recording renal pelvic pressure (third pelvic cannula) to avoid mechanoreceptor activation. We used either normotonic saline (308 mOsm/L), hypertonic saline (500 mOsm/L) or a mixture of hypertonic saline and amiloride (10 μM). We compared these results to instrumented sham rats without any infusion. After 2 hours, rats were deeply anesthetized and perfused transcardially with saline then 4% paraformaldehyde. Brains were removed and sectioned (50 μm) and stained immunohistochemically for c‐fos, a marker of increased neuronal activity. We observed labeled neurons within several regions of the CNS using ImageJ software. A number of regions known to regulate visceral input and/or sympathetic outflow in the brain were activated including the parabrachial nucleus (PBN), paraventricular hypothalamus (PVH), and nucleus tractus solitarius (NTS). The most consistent activation was observed in the PBN el‐inner (151 cells/mm2), parvocellular PVH (113 cells/mm2), and NTS (89.3 cells/mm2) compared to normal saline infusion (80.5, 58.4, and 61.4 cells/mm2 respectively) and sham treatment (34.8, 62.1, and 29.9 cells/mm2 respectively). The activation with hypertonic saline was attenuated by amiloride (16.1, 93.2, and 35.0 cells/mm2 respectively). Therefore, the results suggest that hypertonic saline activates c‐fos in the PBN el‐inner, parvocellular PVH, and NTS, in addition to other areas. Since the activation could be antagonized with an ENaC antagonist in the renal pelvis, we propose that the afferents have ENaC. We have identified specific renal afferent projections and developed a technique for determining selective projections from the renal pelvis. It remains to be determined whether these ENaC and specific renal sensory nerves are responsible for facilitating the development of hypertension.Support or Funding InformationSupported by St. Louis University and Washington University

MP58-15 SUCTIONING FLEXIBLE URETEROSCOPY WITH AUTOMATIC CONTROL OF RENAL PELVIC PRESSURE: A PORCINE MODEL

INTRODUCTION AND OBJECTIVES: We designed a novel technique of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure (RPP) by a patented system including a pressuremeasuring ureteral access sheath (UAS) and an irrigation and suctioning platform. We sought to compare RPP values measured by the irrigation and suctioning platform and a nephrostomy catheter at different phases of flexible ureteroscopy when flow rate was set at 100 mL/min. METHODS: Eight young female pigs with a total of 16 macroscopically normal upper urinary tract systems were included .Via a subcostal incision a 6-F catheter was placed into the renal pelvis for RPP measurement by connecting to a pressure monitor. We then introduced the patented UAS (12-15F) retrogradely into the renal pelvis, through which the pressure was measured by the platform. RPP was measured at baseline period, irrigation and suctioning period, and therapeutic period. RESULTS: Twelve renal pelves were successfully established animal models for flexible ureteroscopy and pressure-measuring. Baseline RPP was 26.9 3.8mm Hg in the platform group and 26.3 5.2mm Hg in the nephrostomy group ( p 1⁄4 0.44). There was no significant difference on RPP between the 2 pressure measuring methods either at irrigation and suctioning period (-5.21+/-2.11 vs. -3.59+/-1.45, p1⁄40.42) or therapeutic period (-5.81+/-2.47 vs. -3.73+/-2.19, p1⁄40.39). CONCLUSIONS: Renal pelvic pressure can be accurately and effectively monitored and controlled using the irrigation and suctioning platform with function of pressure feedback and suctioning UAS with function of pressure-measuring.

MP58-16 DAMAGE TO POLYTETRAFLUOROETHYLENE-COATED GUIDEWIRES: A POTENTIAL FOREIGN BODY RISK

INTRODUCTION AND OBJECTIVES: We designed a novel technique of suctioning flexible ureteroscopy with automatic control of renal pelvic pressure (RPP) by a patented system including a pressuremeasuring ureteral access sheath (UAS) and an irrigation and suctioning platform. We sought to compare RPP values measured by the irrigation and suctioning platform and a nephrostomy catheter at different phases of flexible ureteroscopy when flow rate was set at 100 mL/min. METHODS: Eight young female pigs with a total of 16 macroscopically normal upper urinary tract systems were included .Via a subcostal incision a 6-F catheter was placed into the renal pelvis for RPP measurement by connecting to a pressure monitor. We then introduced the patented UAS (12-15F) retrogradely into the renal pelvis, through which the pressure was measured by the platform. RPP was measured at baseline period, irrigation and suctioning period, and therapeutic period. RESULTS: Twelve renal pelves were successfully established animal models for flexible ureteroscopy and pressure-measuring. Baseline RPP was 26.9 3.8mm Hg in the platform group and 26.3 5.2mm Hg in the nephrostomy group ( p 1⁄4 0.44). There was no significant difference on RPP between the 2 pressure measuring methods either at irrigation and suctioning period (-5.21+/-2.11 vs. -3.59+/-1.45, p1⁄40.42) or therapeutic period (-5.81+/-2.47 vs. -3.73+/-2.19, p1⁄40.39). CONCLUSIONS: Renal pelvic pressure can be accurately and effectively monitored and controlled using the irrigation and suctioning platform with function of pressure feedback and suctioning UAS with function of pressure-measuring.

MP51-04 A NOVEL TECHNIQUE OF SUCTIONING FLEXIBLE URETEROSCOPY WITH AUTOMATIC CONTROL OF RENAL PELVIC PRESSURE: AN INITIAL EXPERIENCE OF 37 CASES

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-04 A NOVEL TECHNIQUE OF SUCTIONING FLEXIBLE URETEROSCOPY WITH AUTOMATIC CONTROL OF RENAL PELVIC PRESSURE: AN INITIAL EXPERIENCE OF 37 CASES Leming Song, Xiaolin Deng, Donghua Xie, Difu Fan, Zuofeng Peng, Tairong Liu, and Zhangqun Ye Leming SongLeming Song More articles by this author , Xiaolin DengXiaolin Deng More articles by this author , Donghua XieDonghua Xie More articles by this author , Difu FanDifu Fan More articles by this author , Zuofeng PengZuofeng Peng More articles by this author , Tairong LiuTairong Liu More articles by this author , and Zhangqun YeZhangqun Ye More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.459AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Flexible ureteroscopy (URS) is rapidly becoming a first line therapy for patients with renal and ureteral calculi. Currently the medical infusion devices can only monitor infusion flow and pressure, but not renal pelvic pressure (RPP). METHODS We designed a patented intelligent system to help flexible URS, including an irrigation and suctioning platform and a ureteral access sheath with a pressure-sensitive tip, which can precisely regulate the infusion flow and control the vacuum suctioning by computerized real-time recording and monitoring of RPP. A stable RPP was ensured by pressure feedback technology. Thirty-seven patients with renal or ureteral calculi participated in the study and received flexible ureteroscopic laser lithotripsy and gravel particles were sucked out automatically. Patients were evaluated on postoperative days 1 and 30 by KUB to assess stone-free status. RESULTS The procedure was successfully performed in all patients with clear operative visualization without a need of stone basketing. The mean stone size was 15.9 +/- 5.2 mm. The mean operative time was 24.8 +/- 15.9 min. The stone-free rates at postoperative days 1 and 30 were 89.2% (33/37) and 94.6% (35/37), respectively. Grade 1 complications were noted in 3 (8.1%) cases according to the Clavien classification, including systemic inflammatory response syndrome in 1 case (2.7%), and fever in 2 cases (5.4%). CONCLUSIONS The patented system is technically feasible, safe, and efficacious for treating upper urinary calculi with advantages of breaking stones more effectively and low complication rates because of its automatic control of RPP. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e682 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Leming Song More articles by this author Xiaolin Deng More articles by this author Donghua Xie More articles by this author Difu Fan More articles by this author Zuofeng Peng More articles by this author Tairong Liu More articles by this author Zhangqun Ye More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP51-07 FLEXIBLE URETEROSCOPY AND LASER LITHOTRIPSY FOR RENAL STONES USING ‘POP-DUSTING’: COMPARISON OF OUTCOMES BETWEEN TRADITIONAL DUSTING SETTINGS VERSUS ULTRA-HIGH FREQUENCY SETTINGS

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-07 FLEXIBLE URETEROSCOPY AND LASER LITHOTRIPSY FOR RENAL STONES USING ‘POP-DUSTING’: COMPARISON OF OUTCOMES BETWEEN TRADITIONAL DUSTING SETTINGS VERSUS ULTRA-HIGH FREQUENCY SETTINGS James Tracey, Galina Gagin, Duncan Morhardt, John Hollingsworth, and Khursid Ghani James TraceyJames Tracey More articles by this author , Galina GaginGalina Gagin More articles by this author , Duncan MorhardtDuncan Morhardt More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , and Khursid GhaniKhursid Ghani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.462AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ″dusting″ technique for laser lithotripsy during flexible ureteroscopy (fURS) has become popular with the advent of multi-cavity high power holmium lasers. However the evidence base in this area is limited, especially regarding different laser settings for dusting. We analyzed our outcomes of dusting for renal stones, before and after acquisition of a 120-watt holmium system that can achieve frequencies of up to 80 Hertz (Hz). METHODS We performed a retrospective review of consecutive fURS for renal stones by a single surgeon using a dusting technique over a 14-month period. Dusting, i.e. high frequency and low pulse energy, was used in two groups: Group 1 using 60-100-watt Holmium:YAG systems with settings of 0.2-0.5 Joules (J) x 30-50Hz; Group 2 using a 120-watt system (Pulse 120H, Lumenis Inc, San Jose, CA) using settings of 0.2-0.5J x 30-80Hz, including the technique of ″Pop-dusting″ (0.5J x 80Hz). All cases were recorded in a database and assessed for stone size, Hounsfield unit (HU), use of staged procedures and ureteral access sheaths (UAS). Stone clearance was determined on post-operative radiography, ultrasound or computed tomography. Complications were classified using the Clavien-Dindo Grade.″ RESULTS Dusting for renal stones was performed in 28 patients in Group 1 and 35 patients in Group 2, including a total of 6 patients with partial staghorn stones. The mean stone sizes were 11.1 (Group 1) and 12.2 mm (Group 2) (p=0.41). The mean body mass index was higher in Group 2 (33.3 vs 29.7, p<0.05). There were no differences in HUs (1015 vs 948, p=0.45), or percentage of solitary (71% vs 74%, p=0.58) or lower pole (25% vs 29%, p=0.78) stones between groups 1 and 2, respectively. UAS was used in 32% (Group 1) and 37% (Group 2) of patients, primarily to keep low intra-renal pelvic pressures. There was no difference in mean laser energy used between groups (7.2kJ vs 6.6kJ, p=0.85, Groups 1 and 2, respectively). The zero-fragment and ≤2 mm-fragment rates were 39% vs 66% (p<0.05), and 57% vs 77% (p=0.11) for Groups 1 and 2, respectively. There were no differences in complications (Group 1: Grade 1-2=3 vs Group 2: Grade 1-2=4). Staged procedures were performed less frequently in Group 2 (11% vs 32%, p=0.06). CONCLUSIONS We demonstrated an improvement in complete stone-free rates when using a dusting technique for renal stones with ultra-high frequencies. Our results suggest dusting during fURS is a reasonable alternative to conventional laser lithotripsy strategies or basket retrieval techniques. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e683 Advertisement Copyright & Permissions© 2016MetricsAuthor Information James Tracey More articles by this author Galina Gagin More articles by this author Duncan Morhardt More articles by this author John Hollingsworth More articles by this author Khursid Ghani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A novel drainage technique during micropercutaneous nephrolithotomy in pediatric patients: double angiocath

Micropercutaneous nephrolithotomy (microperc) is a recently introduced percutaneous nephrolithotomy (PNL) technique that has the smallest tract size. The absence of an amplatz sheath during the microperc technique is a fundamental difference that distinguishes it from all other types of PNL (standard, mini, ultramini). Increasing of the intrarenal pelvic pressure (IPP) was demonstrated by the authors in adult patients but this problem may be even more serious in pediatric patients. Previously, the authors defined the use of a 14 gauge angiocath needle and sheath (microsheath) during microperc surgery for pediatric patient to reduce the IPP. In this novel technique, a second angiocath is used to access the renal collecting system to drain fluid during surgery. This technique is more effective in reducing IPP during microperc, especially in pediatric patients.

Animal Experimental Study to Test Application of Intelligent Pressure Control Device in Monitoring and Control of Renal Pelvic Pressure During Flexible Ureteroscopy

To investigate the application of intelligent pressure control devices (medical irrigation and suctioning platform with pressure feedback function, and suctioning ureteral access sheath with pressure-measuring function) in flexible ureteroscopy for monitoring and control of renal pelvic pressure. Nine pigs with a total of 18 kidneys were randomly divided into 3 groups according to varied renal perfusion flow rates: group A, 50 mL/min; group B, 100 mL/min; and group C, 150 mL/min. A ureteral catheter connected to an invasive blood pressure monitor was retrogradely placed to the upper renal calyx to measure upper calyceal pressure; the suctioning sheath was connected to a 3-channel tubing and was connected to an invasive blood pressure monitor; and the platform and renal pelvic outlet pressure was measured. Perfusion flow, intraluminal pressure control, and warning values were preset on the platform. A flexible ureteroscope was inserted into the upper, mid, and lower renal calyces, and to the front end of the sheath, respectively, each location was irrigated for 5 minutes, and pressure was measured every second. No statistical significance was found between monitor renal pelvic outlet pressure and platform renal pelvic outlet pressure for each group, or between platform renal pelvic outlet pressure and upper renal caliceal pressure for each group at different locations when varied irrigation flow rates were used, or among groups for platform renal pelvic outlet pressure at various irrigation flow rates. The intelligent devices used in the flexible ureteroscopy can reliably and stably monitor and control the renal pelvic pressure within a safety range.

Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study

BackgroundOver the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation. ObjectiveThe aim of our study was to identify the complication rate of power morcellation at our institution. Study designWe performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded. ResultsA total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall complication rate of laparoscopic supracervical hysterectomy was 4.3% (n=8). Need for reoperation after laparoscopic supracervical hysterectomy was necessary in 7 patients (3.8%), with cervical amputation being the most common type of reoperation (n=5). In the laparoscopic-assisted vaginal hysterectomy group there were significantly more adhesiolysis performed (n=4). Parasitic myomas were discovered in 1 patient two years after morcellation (0.5%). ConclusionOur study showed no injuries directly related to morcellation. There were no unexpected malignancies morcellated and only one case of parasitic myomas (0.5%).

Monitoring renal pelvic pressure during retrograde intrarenal surgery with syringe irrigation

Objective To monitor intraluminal renal pelvic pressure during retrograde intrarenal surgery(RIRS) with syringe irrigation and to investigate the safety of this irrigation method. Methods Seven patients admitted for the flexible ureteroscopic lithoripsy with indwelling nephrostomy tube were enrolled.Two males and 5 femals, with the age from 29 to 58 years (median 48 years). The renal pelvic pressure was measured by the pressure transducer during RIRS. Results In the 7 cases, the mean intra-pelvic pressure(IPP) ranged from 5.1 to 54.8 cm H2O, the maximum intra-pelvic pressure(IPPmax) ranged from 12 to 158 cmH2O, the time of lithotripsy ranged from 8.25 to 54.73 min (median 23.12 min), the water consumption ranged from 250 to 2300 ml(median water consumption 640 ml), and the mean irrigation rate ranged from 27.19 to 40.02 ml/min (median irrigation rate 31.14 ml/min), respectively. Conclusions The intraluminal renal pelvic pressure during retrograde intrarenal surgery (RIRS) with syringe irrigation can be controlled at a low level. The cooperation of pushing water during RIRS by the assistant is crucial. The syringe irrigation method has the advantages of controllable pressure, a rapid adjustment, negative pressure suction in necessity and short duration of high pressure. Key words: Renal pelvic pressure; Flexible ureteroscope; Lithotripsy

Pelvic pressure changes after a fracture: A pilot cadaveric study assessing the effect of pelvic binders and limb bandaging

Pelvic pressure changes after a fracture: A pilot cadaveric study assessing the effect of pelvic binders and limb bandaging

Pyomyoma Following Uterine Artery Embolization (UAE) – Dual Case Report and Review of Literature

Background: Leiomyoma commonly referred to, as fibroids are benign smooth muscle tumors of the uterus. Leiomyomas are the most common solid pelvic tumors in women. The most commonly reported symptoms of leiomyoma are abnormal uterine bleeding and increased pelvic pressure. Uterine Artery Embolization (UAE) is a technique performed by interventional radiologists that involves the occlusion of the uterine arteries via a percutaneous femoral artery approach. This is one of many procedures that may be chosen to treat leiomyoma in symptomatic women and results in the devascularization and involution of the tumor. Pyomyoma is a rare condition that occurs when a leiomyoma has become infected and suppurated after infarction. The formation of a pyomyoma can lead to sepsis and death unless treated with aggressive surgical intervention and antibiotics. Case(s): This manuscript represents two cases of pyomyoma following Uterine Artery Embolization (UAE). The diagnosis and management of such a rare complication is described. Conclusion: The rarity of pyomyomas often leads to a missed or delayed diagnosis and subsequently life threatening complications such as peritonitis, septicemia, and respiratory distress syndrome may result. Upon confirmation of the presence of pyomyoma surgical intervention in the form of myomectomy or hysterectomy is the primary method of treatment.

The New Generation Mini-PCNL System - Monitoring and Controlling of Renal Pelvic Pressure by Suctioning Device for Efficient and Safe PCNL in Managing Renal Staghorn Calculi

Introduction: In order to better control renal pelvic pressure (RPP), reduce surgical complications and increase operative efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL), we designed an MPCNL with intelligent monitoring and control of RPP and sought to explore its clinical efficacy and characteristics. Subject and Methods: This study included 60 patients with renal staghorn calculi. A 5F ureteral catheter was connected to an invasive blood pressure monitor for monitoring and control of RPP. A 12F renoscope was inserted through a percutaneous tract for lithotripsy using a laser, with the help of an intelligent system to monitor RPP continuously, which includes an irrigation and suctioning platform and an integrated intraluminal pressure sensory PCNL suctioning sheath. Before the lithotripsy, intraluminal pressure control value and perfusion flow were set on the platform. Results: RPP was maintained at a range of -12 to 2 mm Hg. The mean operative time was 120 min. The mean intraoperative bleeding amount was 100 ml. Fifty-two of the 60 patients the stones were cleared by one surgery. Conclusions: In our suctioning MPCNL with the intelligent control of RPP, the intraoperative RPP could be accurately controlled within the preset safety range. The stone clearance rate was high.

Effects of Alpha-Blockade on Ureteral Peristalsis and Intrapelvic Pressure in an In Vivo Stented Porcine Model.

Clinical studies have shown beneficial role of oral alpha-blockers for ureteral stent-related morbidity. However, the in vivo effects of oral alpha-blockers on a stented ureter are unclear. We evaluated the effects of alpha-blockade on ureteral dynamics in a stented porcine ureter. Twenty-seven female pigs were used in this study. Fourteen pigs received oral alpha-blocker medication (silodosin, 8 mg daily), and 13 pigs received no medication. Under cystoscopic guidance, a 5F ureteral catheter was positioned in the renal pelvis and attached to a pressure monitor. A Foley catheter was placed in the bladder along with a bladder pressure transducer. A lumbotomy was performed, and the ureter was identified. A magnetic sensor was placed on the extraluminal surface of the ureter to monitor ureteral peristalsis. We measured renal pelvic and bladder pressures, urine output, and ureteral peristalsis every hour for 10 minutes for a total of 5 hours. The pigs were then euthanized. The mean weight was 42.5 kg in the drug group and 45.9 kg in the nondrug group (p = 0.008). Mean hourly urine output was 140 mL in the drug group and 144 mL in the nondrug group (p = 0.76). Mean baseline renal pressure was 13.2 and 13.8 mm Hg (p = 0.69) in the drug and nondrug groups, respectively. Mean peristaltic renal pelvic pressure was 19.1 mm Hg in the drug group and 19.2 mm Hg in the nondrug group (p = 0.97). Mean number of peristalsis was 11/10 and 14/10 minutes (p = 0.03) in the drug and nondrug groups, respectively. Alpha-blockade in an in vivo stented porcine ureter resulted in no significant effect on renal pelvic pressure but a significant decrease in the number of ureteral peristalsis. Further investigation of the effects of alpha-blocker on ureteral dynamics is required to better understand its effects on stent-related symptoms.

Should Prophylactic Anticoagulation Be Considered with Large Uterine Leiomyoma? A Case Series and Literature Review.

Introduction. Uterine leiomyomas, also called uterine fibroids or myomas, are the most common pelvic tumors in women. They are very rarely the cause of acute complications. However, when complications occur they cause significant morbidity and mortality. Thromboembolic disease has been described as a rare complication of uterine leiomyomas. DVT is a serious illness, sometimes causing death due to acute PE. Cases. We report a case series of 3 patients with thromboembolic disease associated with uterine leiomyoma at Hurley Medical Center, Flint, Michigan, during 2015 and conduct a literature review on the topic. A literature search was conducted using Medline, PubMed, and PMC databases from 1966 to 2015. Conclusion. The uterine leiomyoma is a very rare cause of PE and only few cases have been reported. DVT secondary to uterine leiomyoma should be considered in a female presenting with abdominal mass and pelvic pressure, if there is no clear common cause for her symptoms. Thromboembolic disease secondary to large uterine leiomyoma should be treated with acute stabilization and then hysterectomy. Prophylactic anticoagulation would be beneficial for lowering the risk of VTE in patients with large uterine leiomyoma.

Influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women.

[Purpose] The aim of the present study was to assess the influence of parity, type of delivery, and physical activity level on pelvic floor muscles in postmenopausal women. [Subjects and Methods] This was an observational analytic cross-sectional study with a sample of 100 postmenopausal women, aged between 45 and 65 years, divided into three groups according to menopausal stage: hysterectomized and early and late postmenopause. Patients were assessed for sociodemographic and gyneco-obstetric factors and subjected to a muscle strength test and perineometry. Descriptive statistics, ANOVA, Kruskal-Wallis and multiple regression were applied. [Results] The results showed homogeneity in sociodemographic and anthropometric characteristics. There was no difference in pelvic floor muscle function among the three groups. Type of delivery, parity and physical activity level showed no influence on muscle function. [Conclusion] The findings demonstrate that parity, type of delivery, and physical activity level had no influence on pelvic floor muscle pressure in postmenopausal women. One hypothesis to explain these results is the fact that the decline in muscle function in postmenopausal women is related to the female aging process.

A comparative study on the effects of MRI- and CT-guided interventional therapies on uterine fibroids.

Objective:To compare the effects of MRI- and CT-guided interventional therapies on uterine fibroids.Methods:A total of 280 patients with uterine fibroids who were treated in our hospital from August 2008 to February 2014 were selected and divided into a treatment group and a control group by random draw (n=140). The control group and the treatment group were subjected to CT- and MRI-guided interventional therapies for uterine artery embolization.Results:After three months of treatment, 94.3% and 92.9% of heavy menstrual bleeding and pelvic pressure of the treatment group were relieved respectively, which were similar to those of the control group (92.9% and 92.1% respectively) (P>0.05). The two groups had similar uterine and fibroid sizes before treatment, which were all significantly decreased after treatment (P<0.05) when the treatment group had significantly smaller uteri and fibroids than the control group did (P<0.05). The serum follicle-stimulating hormone, luteinizing hormone, estradiol levels, arterial resistive indices and endometrial thicknesses of the two groups were similar before treatment, which were significantly increased after treatment (P<0.05). Meanwhile, the values of the two groups became significantly different (P<0.05). The treatment group was also significantly less prone to complications such as fever, vaginal bleeding and hematuria than the control group after treatment (P<0.05).Conclusion:Interventional therapy, especially that guided by MRI, can be performed accurately and safely by mildly affecting the ovary and by promoting the recovery of uterine artery blood flow and endometrial thickness.

Suctioning Flexible Ureteroscopy with Automatic Control of Renal Pelvic Pressure

Introduction: Flexible ureteroscopy (URS) is becoming a first-line therapy for many patients with renal and ureteral calculi rapidly.1 Current commonly used medical infusion devices can only monitor the infusion flow and infusion pressure, but not the renal pelvic pressure (RPP).2,3 We sought to invent a novel technique of suctioning flexible URS with an intelligent control of RPP.Materials and Methods: We performed flexible URSs for patients with the help of a self-designed intelligent system, including an irrigation and suctioning platform and a transparent ureteral access sheath (UAS) with a pressure-sensitive tip, which can precisely regulate the infusion flow and control the vacuum suctioning by computerized real-time recording and monitoring of RPP through pressure feedback, ensuring a stable RPP. The outer body diameter of the UAS was 15F; the diameter of the working channel was 11.55F; and the length of the UAS was 20 to 45 cm. On the platform, RPP control value was set at −2 mm Hg, RPP warning value was set at 20 mm Hg, and RPP limit value was set at 30 mm Hg. Intraoperatively, Holmium laser was used to powderize the stone at 0.8 J/pulse with a frequency of 20 pulses/second (Lumenis, fiber diameter 200 μm). In the process of powderizing lithotripsy using the laser, the scope body was moved back and forth slightly in an uninterrupted manner in the sheath, with a distance of about 2 to 3 mm, to facilitate small gravel particles inside the sheath gap to be sucked out automatically. Gravel particles, larger than sheath gap but less than UAS in diameter, were sucked out by withdrawing the scope intermittently without a need of stone basketing. We retrospectively reviewed 51 patients with renal or ureteral calculus (55 renal units, 9 ureteral calculi), who received the flexible URS from November 2014 to March 2015.Results: We were able to perform all the procedures with clear operative visualization. The mean stone size was 16.1±3.9 mm. The mean operative time was 22.3±16.4 minutes. The stone-free rate on postoperative day 30 was 93.8% (60/64) by the kidney, ureter, and bladder radiograph. No patient had a sepsis.Conclusions: Flexible URS with the help of our intelligent system is technically feasible, safe, and efficacious for treating upper urinary tract calculi with the advantages of breaking stones at high efficacy and low complication rates because of its automatic control of RPP.Acknowledgment: The research project was funded by the Science and Technology Department of Jiangxi Province and was listed as a major project of the Science and Technology Department of Jiangxi Province with a number of 20152ACG70009.No competing financial interests exist.Runtime of video: 9 mins 52 secs

Continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with urinary incontinence

To evaluate continuous improvement of portable domestic pelvic floor neuromuscular electrical stimulation on the pelvic floor function of patients with stress urinary incontinence after short-term pelvic floor electrophysiological treatment in hospital. Totally 60 women with stress urinary incontinence were recruited for this randomized controlled trial. The control group including a total of 30 patients, only received 4 weeks pelvic floor electrophysiological treatment in the hospital. Family consolidation treatment group (experimental group) including 30 patients, after 4-week treatment in hospital, received 12-week of pelvic floor neuromuscular electrical stimulation using portable electrical stimulator at home under the guidance of doctors. In post-treatment 6 months and 9 months, 1-hour pad test was measured for urine leakage, pelvic floor electrical physiological parameters were assessed, and subjective improvement of symptoms of urinary incontinence were evaluated. All these data were analysed to compare the effect of the two groups. In 9 months after treatment, average change of urine leakage, the control group and experiment group were (75±24)% versus (99±3)%, the difference was statistically significant (P<0.01). In the experiment group, strength of type I muscle (4.4±0.7), strength of type II muscle (4.8±0.4) and pelvic floor dynamic pressure [(96±12) cmH(2)O, 1 cmH(2)O=0.098 kPa] were better than those of control group [3.2±1.0, 4.3±0.9, (86±10) cmH(2)O, respectively], the differences were statistically significant (P<0.01). Subjective outcome, the control group and experiment group were (6.5±2.9) versus (1.8±1.7), subjective outcome between the two groups had significant difference (P<0.01). After short-term pelvic floor electrophysiological treatment in hospital, the portable domestic pelvic floor neuromuscular electrical stimulation in patients with stress urinary incontinence is helpful to continuous improvement of pelvic floor function.