Trial reportThe British journal of surgery2024
Intrarenal pressure with hand-pump or pressurized-bag irrigation: randomized clinical trial at retrograde intrarenal surgery.
Trial report in The British journal of surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Objective assessment of turbidity during laser lithotripsy: standardization of a dedicated in vitro experimental model.World journal of urology · 2026Article
- Real-world DISS practice combined with and without access sheath: insights from the global DISS dataset: a EAU endourology study.World journal of urology · 2026Article
- Monitoring Intrarenal Pressure vs. Irrigation Fluid Absorption for Infection Prevention in Ureteroscopy.Advances in urology · 2026Review
- Automated intrarenal pressure control in flexible ureteroscopy using an integrated ureteroscope pressure measurement and fluid management system: first-in-human use.World journal of urology · 2025Observational
- Iatrogenic upper urinary tract injuries during ureteroscopy for urolithiasis: a comprehensive review on incidence, mechanisms and preventative strategies.Nature reviews. Urology · 2025Review
- Intrarenal pressure and stone fragment retrieval efficiency using foot-controlled irrigation in combination with a flexible, navigable Suction ureteral access sheath: an in vitro kidney model study.World journal of urology · 2025Article
- Construction and validation of a nomogram to predict urosepsis in patients with symptomatic ureterolithiasis after ureteroscopic lithotripsy.Urolithiasis · 2025Article
- Intrarenal pressure variations during flexible ureteroscopy in a porcine kidney model: impact of ureteral access sheath types and irrigation methods.World journal of urology · 2025Article
- Comparative efficacy and safety of flexible and navigable suction sheath versus non-flexible suctioning ureteral access sheath in retrograde intrarenal surgery for renal stones: a propensity score-matched retrospective cohort study.World journal of urology · 2025Article
- Mind the pressure - Why does intrarenal pressure monitoring matter? Overview from EAU endourology.Therapeutic advances in urologyArticle
- Current utility, instruments, and future directions for intra-renal pressure management during ureteroscopy: scoping review by global research in intra-renal pressure collaborative group initiative.Therapeutic advances in urologyArticle
Corrections and comments
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Authors and funding
10 authors.
Funding
Abstract
backgroundThe aim was to ascertain the impact of irrigation technique on human intrarenal pressure during retrograde intrarenal surgery.
methodsA parallel randomized trial recruited patients across three hospital sites. Patients undergoing retrograde intrarenal surgery for renal stone treatment with an 11/13-Fr ureteral access sheath were allocated randomly to 100 mmHg pressurized-bag (PB) or manual hand-pump (HP) irrigation. The primary outcome was mean procedural intrarenal pressure. Secondary outcomes included maximum intrarenal pressure, variance, visualization, HP force of usage, procedure duration, stone clearance, and clinical outcomes. Live intrarenal pressure monitoring was performed using a COMETTMII pressure guidewire, deployed cystoscopically to the renal pelvis. The operating team was blinded to the intrarenal pressure.
resultsThirty-eight patients were randomized between July and November 2023 (trial closure). The final analysis included 34 patients (PB 16; HP 18). Compared with PB irrigation, HP irrigation resulted in significantly higher mean intrarenal pressure (mean(s.d.) 62.29(27.45) versus 38.16(16.84) mmHg; 95% c.i. for difference in means (MD) 7.97 to 40.29 mmHg; P = 0.005) and maximum intrarenal pressure (192.71(106.23) versus 68.04(24.16) mmHg; 95% c.i. for MD 70.76 to 178.59 mmHg; P < 0.001), along with greater variance in intrarenal pressure (log transformed) (6.23(1.59) versus 4.60(1.30); 95% c.i. for MD 0.62 to 2.66; P = 0.001). Surgeon satisfaction with procedural vision reported on a scale of 10 was higher with PB compared with HP irrigation (mean(s.d.) 8.75(0.58) versus 6.28(1.27); 95% c.i. for MD 1.79 to 3.16; P < 0.001). Subjective HP usage force did not correlate significantly with transmitted intrarenal pressure (Pearson R = -0.15, P = 0.57). One patient (HP arm) developed urosepsis.
conclusionManual HP irrigation resulted in higher and more fluctuant intrarenal pressure trace (with inferior visual clarity) than 100-mmHg PB irrigation. REGISTRATION NUMBER: osf.io/jmg2h (https://osf.io/).
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