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. 2025 Jun 16;43(1):373.
doi: 10.1007/s00345-025-05744-9.

Intrarenal pressure management using flexible ureteroscope with direct in-scope suction in combination with different size ureteral access sheaths: an experimental ex-vivo study

Arman Tsaturyan  1   2   3   4 , Victoria Jahrreiss  5   6 , Lusine Kocharyan  7 , Marco Lattarulo  8 , Armen Muradyan  9 , Marat Harutyunyan  10 , Gevork Manvelyan  10 , Eugenio Ventimiglia  5   11   12 , Angelis Peteinaris  13 , Vasileios Tatanis  13 , Evangelos Liatsikos  11   13 , Panagiotis Kallidonis  11   13 , Steffi Kar Kei Yuen  11   14 , Vineet Gauhar  11   15 , Olivier Traxer  11   16 , Bhaskar Somani  11   17 , Amelia Pietropaolo  5   11   17
Affiliations

Intrarenal pressure management using flexible ureteroscope with direct in-scope suction in combination with different size ureteral access sheaths: an experimental ex-vivo study

Arman Tsaturyan et al. World J Urol. .

Abstract

Purpose: To evaluate the impact of direct in-scope suction (DISS) on intrarenal pressure (IRP) using two different-sized flexible ureteroscopes (7.5Fr and 9.2Fr) in combination with various sized ureteral access sheaths (UAS).

Material and methods: In this ex-vivo experimental study using a porcine kidney model, pressure measurements were conducted using two venous catheters placed in the upper and lower calyces. We tested 7.5Fr (3.6Fr working channel) and 9.2Fr (5.1Fr working channel) flexible ureteroscopes with DISS systems with 9.5/11.5Fr, 11/13Fr, and 12/14Fr UASs. Measurements were taken at irrigation pressures of 40-100 mmHg, evaluating the effects of suction modes (none vs active).

Results: The 9.2Fr scope generated higher baseline pressures (maximum 23 mmHg) compared to the 7.5Fr scope (maximum 7 mmHg) at 100 mmHg irrigation. One second of active achieved significant pressure reduction from 20-23mmHG to 3 mmHg for 9.2Fr DISS scope with 100 mmHg pressure setting and to 0 mmHg in all other settings with both scopes. The 9.2Fr scope demonstrated faster pressure recovery (8-14 s) compared to the 7.5Fr scope (10-32 s).

Conclusions: Higher intrarenal pressures can be expected with the 9.2Fr scope compared to the 7.5Fr scope, regardless of irrigation power and UAS size. Rapid and significant reduction of pressure occurs only after 1 s of suction activation. This effect is more pronounced with the 9.2Fr ureteroscope that is supplied with a wider working channel measuring 5.1Fr. The 9.2Fr scope requires shorter time to regain initial pressure compared to the 7.5Fr scope (3.6Fr working channel).

Keywords: Direct in-scope suction; Endourology; Flexible ureteroscopy; Intrarenal pressure; Ureteral access sheath.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests.

References

    1. Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol 69(3):468–474 - DOI - PubMed
    1. Doizi S, Traxer O (2018) Flexible ureteroscopy: technique, tips and tricks. Urolithiasis 46(1):47–58 - DOI - PubMed
    1. Somani BK, Giusti G, Sun Y et al (2017) Complications associated with ureterorenoscopy (URS) related to treatment of urolithiasis: the clinical research office of endourological society URS global study. World J Urol 35(4):675–681 - DOI - PubMed
    1. Doizi S (2021) Intrarenal pressure: what is acceptable for flexible ureteroscopy and percutaneous nephrolithotomy? Eur Urol Focus 7(1):31–33 - DOI - PubMed
    1. Jung H, Osther PJ (2015) Intraluminal pressure profiles during flexible ureterorenoscopy. Springerplus 4:373 - DOI - PubMed - PMC

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