Our experiences of measuring the intrarenal pressure by using the Lithovue Elite Digital Flexible Ureteroscope

Tzu-Hsuan Fan, Cheng-Chia Lin

Keelung Chang Gung Memorial Hospital, Department of Urology

使用LithoVue Elite 數位軟式輸尿管鏡系統監測術中腎內壓:我們的經驗

范子宣、林承家

基隆長庚紀念醫院 泌尿部

Abstract: Regarding intra-renal pressure (IRP), We also have 4 cases of interesting experiences. Using a scope that can measure intrarenal pressure, I always insert the scope after positioning the access sheath where I want it and measure the intrarenal pressure before starting the procedure. First, I measure the minimum pressure required to distend the renal collecting system, which is called the floor pressure. Then, I inject contrast medium, and the pressure measured at the moment when pelvic venous reflux occurs is called the ceiling pressure. The range between these two values is the best therapeutic pressure window (BTPW). I have found that each person and each kidney has a different BTPW; it's not always 30 or 40 mmHg as the literature suggests. Kidneys that have been obstructed have a very wide BTPW, while those without obstruction have a very narrow BTPW. In cases of renal hydronephrosis ,the ceiling pressure can even reach 100 mmHg, while in non-hydronephrosis cases, the ceiling pressure is only 30 mmHg. This gives us, as clinicians, something to reflect on during surgery, especially for patients with infection concerns. In cases where the access sheath can only be placed in the upper ureter, when dealing with minor calyx stones, the pressure often spikes. However, if we proceed with lithotripsy without reposition the stones,postoperative follow-ups do not seem to show any particular signs of infection. Therefore, whether IRP should be strictly adhered to remains a topic for discussion."