Emerging Topics in Ureteroscopy: Pressure, Temperature, and Suction
Seth K. Bechis, MD, discusses methods to reduce pain, sepsis, and other complications in the use of ureteroscopy to treat renal conditions. He begins by examining the relationship between intrarenal pressure (IRP), pain, and infection. He discusses the importance of monitoring IRP during ureteroscopy, and explores methods of reducing IRP, including irrigation control.
Dr. Bechis then discusses the issue of thermal injury in ureteroscopy. He illustrates the benefits of proper irrigation, shorter laser pedal activation time, and laser setting in preventing the denaturation of proteins in the kidney. He compares the temperatures generated by Holmium and TFL lasers, noting that TFL is a higher-energy option.
Dr. Bechis concludes by examining the role of suction in renal stone removal. He presents a demonstration of various suction devices and discusses their strengths and limitations. He warns that the use of a suction device lengthens the duration of the procedure and that suction still has room for improvement as a treatment.
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