Distension of the renal pelvis in kidney stone patients: sensory and biomechanical responses.

Abstract

The pathogenesis of symptoms in urolithiasis is poorly understood. Traditionally increased endoluminal pressure is considered the main mechanism causing pain in the upper urinary tract but clinical data are sparse. The aim of the present study was to develop a new model related to mechanosensation in order to describe the geometric and mechanical properties of the renal pelvis in patients with kidney stone disease. Pressure measurement in the renal pelvis was done during CT-pyelography in 15 patients who underwent percutaneus nephrolithotomy. The sensory intensity was recorded at the thresholds for first sensation and for pain. 3D deformation and strain were calculated in five patients. The deformation of pelvis during distension was not uniform due to the complex geometry. The pelvis deformed to 113 ± 6% and 115 ± 11% in the longitudinal and circumferential directions, respectively. Endoluminal pressure in the renal pelvis corresponded positively to the sensory ratings but the referred pain area was diffuse located and varied in size. The present study provides a method for describing the mechanosensory properties and 3D deformation of the complex renal pelvis geometry. Although there was a relation between pressure and pain score, the non-homogenous spatial strain distribution suggests that the 3D biomechanical properties of the renal pelvis are not reflected by simple estimates of tension based on pressure and volume.