ArticleBJU international2026
Intrarenal thermal and pressure dynamics during ureteroscopy: an in vitro study.
Article in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo evaluate in vitro determinants of intrarenal temperature (IRT) and pressure (IRP) during laser lithotripsy. MATERIALS AND
methodsA silicone urinary tract model was used to perform laser lithotripsy on artificial stones placed in the renal pelvis. Three laser sources (thulium fibre laser, holmium:yttrium-aluminium-garnet [Ho:YAG] with Magneto Technology, and pulsed thulium:YAG) with 200-μm fibres were tested at four energy settings (0.6 J-10 Hz, 1 J-10 Hz, 0.2 J-50 Hz, and 1 J-40 Hz), delivering 2000 J per experiment. Irrigation was provided by gravity (40 cmH
resultsBaseline temperatures were comparable among groups (27.2-32.2 °C, P > 0.05). Hand-pump irrigation reduced mean IRT compared to gravity (-9.1 °C, P = 0.001). Laser power showed a dose-response effect (10 W: +2.5 °C, P = 0.003; 40 W: +8.2 °C, P = 0.001 vs 6 W). At equivalent power and irrigation settings, laser source did not influence IRT under the experimental conditions evaluated. The thermal-risk threshold (>43 °C) was reached in 16.7% of experiments, increased with power (2.8%, 15.3%, and 41.7% at 6, 10, and 40 W; P = 0.001) and decreased with hand-pump irrigation and FANS (P < 0.05). Hand-pump irrigation increased IRP by 21 cmH
conclusionsMean IRT was associated with laser power and irrigation strategy. High-power settings (40 W) frequently exceeded the thermal-risk threshold. Although FANS was not associated with lower mean IRT, it reduced the likelihood of exceeding the thermal-risk threshold. Laser source had no effect on mean IRT when power and irrigation conditions were comparable. Mean IRP was influenced by irrigation strategy and UAS configuration but was not associated with mean IRT. These findings underscore the need for advanced integrated irrigation-aspiration systems capable of dynamic control of flow, pressure, and temperature to optimise procedural safety.
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