# Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model

Doizi, Steeve; Uzan, Audrey; Keller, Etienne Xavier; De Coninck, Vincent; Kamkoum, Hatem; Barghouthy, Yazeed; Ventimiglia, Eugenio; Traxer, Olivier (2021). Comparison of intrapelvic pressures during flexible ureteroscopy, mini-percutaneous nephrolithotomy, standard percutaneous nephrolithotomy, and endoscopic combined intrarenal surgery in a kidney model. World Journal of Urology, 39(7):2709-2717.

## Abstract

PURPOSE

To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model.

METHODS

A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH$_{2}$O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr.

RESULTS

f-URS: IPP values ranged between 1.4 and 46.2 cmH$_{2}$O. Factors reducing IPP were an irrigation pressure at 40 cmH$_{2}$O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH$_{2}$O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH$_{2}$O. Factors reducing IPP were irrigation pressure at 40 cmH$_{2}$O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH$_{2}$O, while it decreased at 193 cmH$_{2}$O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH$_{2}$O. Occupancy of the working channel did not affect IPP at 40 cmH$_{2}$O, while it increased at 193 cmH$_{2}$O.

CONCLUSION

We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH$_{2}$O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH$_{2}$O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.

## Abstract

PURPOSE

To compare intrapelvic pressure (IPP) levels achieved during f-URS, mini-PCNL, standard PCNL, and endoscopic combined intrarenal surgery in a kidney model.

METHODS

A silicone model simulating the complete urinary tract was used for all the experiments. We compared: a 9.5Fr f-URS, a 12Fr mini-nephroscope and a 26Fr nephroscope. The irrigation pressure was set at 40 and 193 cmH$_{2}$O. We compared: f-URS-S ± ureteral access sheath (UAS, 10/12Fr, 11/13Fr, 12/14Fr) ± 273 μm laser fiber, Mini-PCNL with different sizes of operating sheath (15/16Fr, 16.5/17.5Fr, 21/22Fr) ± 365 μm laser fiber, Standard PCNL with an operating sheath of 30Fr ± Lithotripter LithoClast Master 11.4Fr.

RESULTS

f-URS: IPP values ranged between 1.4 and 46.2 cmH$_{2}$O. Factors reducing IPP were an irrigation pressure at 40 cmH$_{2}$O, an occupied working channel, and the use of a UAS except with the 10/12Fr at 193 cmH$_{2}$O. Mini-PCNL: IPP values ranged between 2.4 and 39.7 cmH$_{2}$O. Factors reducing IPP were irrigation pressure at 40 cmH$_{2}$O, a large operating sheath (> 15/16Fr). The occupation of the working channel did not affect the IPP at 40 cmH$_{2}$O, while it decreased at 193 cmH$_{2}$O. Standard PCNL: IPP values ranged between 1.4 and 7.3 cmH$_{2}$O. Occupancy of the working channel did not affect IPP at 40 cmH$_{2}$O, while it increased at 193 cmH$_{2}$O.

CONCLUSION

We recorded for the first time IPP values according to different endourological techniques and configurations. IPP never exceed 50 cmH$_{2}$O irrespectively of the assessed technique/setup. The factors reducing IPP were a low irrigation pressure (40 cmH$_{2}$O), the use of a UAS or a working sheath appropriate to the diameter of the endoscope, as well as the occupation of the working channel in the case of f-URS.

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