Upper urinary tract pressures in endourology: a systematic review of range, variables and implications

作者：Stefanie Croghan, Andreas Skolarikos, Gregory S. Jack, Rustom P. Manecksha, Michael T. Walsh, Fergal J. O’Brien, Niall F. Davis · 发表于：British Journal of Urology · 年份：2022 · DOI：10.1111/bju.15764 · 被引用次数：73 · 研究领域：Kidney Stones and Urolithiasis Treatments、Ureteral procedures and complications、Urinary Tract Infections Management

Objectives To systematically review the literature to ascertain the upper tract pressures generated during endourology, the relevant influencing variables and clinical implications. Materials and Methods A systematic review of the MEDLINE, Scopus and Cochrane databases was performed by two authors independently (S.C., N.D.). Studies reporting ureteric or intrarenal pressures (IRP) during semi‐rigid ureteroscopy (URS)/flexible ureterorenoscopy (fURS)/percutaneous nephrolithotomy (PCNL)/miniaturized PCNL (mPCNL) in the period 1950–2021 were identified. Both in vitro and in vivo studies were considered for inclusion. Findings were independently screened for eligibility based on content, with disagreements resolved by author consensus. Data were assessed for bias and compiled based on predefined variables. Results Fifty‐two studies met the inclusion criteria. Mean IRP appeared to frequently exceed a previously proposed threshold of 40 cmH 2 O. Semi‐rigid URS with low‐pressure irrigation (gravity <1 m) resulted in a wide mean IRP range (lowest reported 6.9 cmH 2 O, highest mean 149.5 ± 6.2 cmH 2 O; animal models). The lowest mean observed with fURS without a ureteric access sheath (UAS) was 47.6 ± 4.1 cmH 2 O, with the maximum peak IRP being 557.4 cmH 2 O ( in vivo human data). UAS placement significantly reduced IRP during fURS, but did not guarantee pressure control with hand‐operated pump/syringe irrigation. Miniaturization of PCNL sheaths was associated with increased IRP; how...