Comparison of the safety of flexible ureteroscopy with the different irrigation methods in a 3D print kidney model.

IF 1.7 3区医学 Q3 UROLOGY & NEPHROLOGY BMC Urology Pub Date : 2024-11-06 DOI:10.1186/s12894-024-01638-x

Baohua Bai, Shuangjian Jiang, Junlong Zhang, Qinsong Zeng, Chengqiang Mo, Rongpei Wu

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Abstract

Objective: To compare intrarenal pressure (IRP) and irrigation flow by varying suspended water heights and hand-held pressure pumping during flexible ureteroscopy using an in vitro 3D printed kidney model.

Methods: A 3D-printed silicone model was used to simulate the kidney. The ureteral access sheath(UAS) was connected to the kidney model and positioned at the ureteropelvic junction. Central venous pressure tubing was used to monitor the pressure in the renal pelvis under different conditions. Sheath sizes of 12Fr and 14Fr were tested with flexible ureteroscope (fURS) sizes of 7.5, 8.5, and 9.5Fr, respectively. The irrigation was gravity-based, with suspended water heights set at 60, 90, 120, 150, and 180 cm. The manual pumping as another set of measurement is used to measure the maximum intrarenal pressure.

Results: Using a 12Fr sheath with a 9.5Fr fURS loading without additional accessories resulted in IRP ranging from 8.4 to 17.5 cmH2O, while manual pumping perfusion pressure exceeded 60 cmH2O. Loading a 200-um laser fiber reduced the pressure to 6.4-10.5 cmH2O, and using a stone basket decreased it to 4.0-5.0 cmH2O. Using a 14Fr sheath with a 9.5Fr fURS resulted in an IRP of 2.5-6.0 cmH2O, compared to 17 cmH2O with manual pumping. With a 12Fr sheath and a 7.5Fr fURS, the IRP ranged from 5.4 to 8.2 cmH2O, while manual pumping resulted in 25.5 cmH2O. With a 14Fr sheath and a 7.5Fr fURS, the IRP ranged from 1.5 to 4.3 cmH2O, and manual pumping resulted in 9.0 cmH2O.

Conclusion: When using a UAS in a flexible ureteroscopy, the IRP can be maintained within a safe range with different fURS/UAS combos with a suspended water height of less than 180 cm. However, with specific fURS/UAS(9.5Fr/12Fr) combos, the IRP exceeded the safe limit when using manual pumping. Gravity irrigation with a suspended water height of less than 180 cm is safe in this simulated clinical environment.

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在 3D 打印肾脏模型中比较柔性输尿管镜检查与不同灌洗方法的安全性。

目的使用体外 3D 打印肾脏模型，通过改变悬浮水高度和手持压力泵在柔性输尿管镜检查过程中比较肾内压（IRP）和灌注流量：方法：使用 3D 打印硅胶模型模拟肾脏。方法：使用 3D 打印硅胶模型模拟肾脏，将输尿管接入鞘连接到肾脏模型，并将其置于输尿管盆腔交界处。中心静脉压力管用于监测不同条件下肾盂内的压力。12Fr 和 14Fr 的鞘分别与 7.5、8.5 和 9.5Fr 的柔性输尿管镜（fURS）进行了测试。灌溉以重力为基础，悬浮水高度分别设置为 60、90、120、150 和 180 厘米。手动抽水作为另一套测量方法，用于测量最大肾内压：结果：使用带有 9.5Fr fURS 负载的 12Fr 鞘，在没有额外附件的情况下，IRP 为 8.4 至 17.5 cmH2O，而手动泵灌注压力超过 60 cmH2O。装入 200um 激光光纤后，压力降至 6.4-10.5 cmH2O，使用石篮后，压力降至 4.0-5.0 cmH2O。使用 14Fr 护套和 9.5Fr fURS，IRP 为 2.5-6.0 cmH2O，而使用手动泵时为 17 cmH2O。使用 12Fr 鞘和 7.5Fr fURS 时，IRP 为 5.4 至 8.2 cmH2O，而手动泵送时为 25.5 cmH2O。使用 14Fr 护套和 7.5Fr fURS 时，IRP 为 1.5 至 4.3 cmH2O，手动抽气为 9.0 cmH2O：结论：在柔性输尿管镜检查中使用 UAS 时，不同的 fURS/UAS 组合（悬浮水高度低于 180 厘米）可将 IRP 保持在安全范围内。然而，在使用特定的 fURS/UAS（9.5Fr/12Fr）组合时，手动抽水的 IRP 超过了安全范围。在这种模拟的临床环境中，悬浮水高度低于 180 厘米的重力灌溉是安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Urology UROLOGY & NEPHROLOGY-

CiteScore

3.20

自引率

0.00%

发文量

177

审稿时长

>12 weeks

期刊介绍： BMC Urology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of urological disorders, as well as related molecular genetics, pathophysiology, and epidemiology. The journal considers manuscripts in the following broad subject-specific sections of urology: Endourology and technology Epidemiology and health outcomes Pediatric urology Pre-clinical and basic research Reconstructive urology Sexual function and fertility Urological imaging Urological oncology Voiding dysfunction Case reports.