Elevated Renal Pelvic Pressures during Percutaneous Nephrolithotomy Risk Higher Postoperative Pain and Longer Hospital Stay

No AccessJournal of UrologyAdult Urology1 Jan 2018Elevated Renal Pelvic Pressures during Percutaneous Nephrolithotomy Risk Higher Postoperative Pain and Longer Hospital Stay Muhannad Alsyouf, Samuel Abourbih, Benjamin West, Herbert Hodgson, and D. Duane Baldwin Muhannad AlsyoufMuhannad Alsyouf More articles by this author , Samuel AbourbihSamuel Abourbih More articles by this author , Benjamin WestBenjamin West More articles by this author , Herbert HodgsonHerbert Hodgson More articles by this author , and D. Duane BaldwinD. Duane Baldwin Financial interest and/or other relationship with DARRT Medical, Olympus, Bard and Cook Medical. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.08.039AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Renal pelvic pressure may vary during percutaneous nephrolithotomy. We sought to determine the relationship of postoperative pain to endoscope caliber, renal pelvic pressure and hospital stay. Materials and Methods: We reviewed the records of 20 percutaneous nephrolithotomies done under ureteroscopic guidance with renal pelvic pressure monitoring. The ureteroscope working channel was connected to a pressure transducer and used to determine renal pelvic pressure at baseline, when irrigating with a 26Fr rigid nephroscope and a 16Fr flexible nephroscope, and during suction. Patient demographics, operative characteristics, Likert pain scores and length of hospital stay were compared as stratified by average renal pelvic pressure. The Mann-Whitney U and Fisher exact tests were used with p <0.05 considered significant. Results: A total of 220 measurements were recorded in 20 patients undergoing single access percutaneous nephrolithotomy. Mean patient age was 55.2 years (range 20 to 77) and mean body mass index was 32.4 kg/m2 (range 18 to 53.3). Rigid nephroscopy resulted in significantly higher average renal pelvic pressure than flexible nephroscopy (30.3 vs 12.9 mm Hg, p = 0.007). Average renal pelvic pressure was 30 mm Hg or greater in 7 patients (35%) undergoing rigid nephroscopy and in none (0%) undergoing flexible nephroscopy (p <0.01). Patients exposed to an average renal pelvic pressure of 30 mm Hg or greater during rigid nephroscopy had significantly higher average pain scores (p = 0.004) and longer hospital stays (p = 0.04) than patients with renal pelvic pressure less than 30 mm Hg. Average renal pelvic pressure 30 mm Hg or greater during rigid nephroscopy was also associated with a longer skin to calyx distance (105.5 vs 79.7 mm, p = 0.03). Conclusions: Knowledge of the factors that influence renal pelvic pressure and methods to control pressure extremes may improve patient outcomes during percutaneous nephrolithotomy. References 1 : The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol2011; 25: 11. Google Scholar 2 : Trends in percutaneous nephrolithotomy use and outcomes in the United States. J Urol2013; 190: 558. Link, Google Scholar 3 : Surgical management of stones: American Urological Association/Endourological Society guideline, part I. J Urol2016; 196: 1153. Link, Google Scholar 4 : Urology: The clinical significance of pyelovenous backflow. Cal West Med1928; 29: 111. Google Scholar 5 : Fluid absorption during percutaneous nephrolithotomy: does it matter?. J Endourol2002; 16: 221. Google Scholar 6 : Intra-renal reflux. Urol Res1985; 13: 253. Google Scholar 7 : Systemic inflammatory response syndrome after percutaneous nephrolithotomy: a randomized single-blind clinical trial evaluating the impact of irrigation pressure. J Urol2016; 196: 109. Link, Google Scholar 8 : Best practice policy statement on urologic surgery antimicrobial prophylaxis. J Urol2008; 179: 1379. Link, Google Scholar 9 : A technique for the measurement of attitudes. Arch Psychol1932; 140: 1. Google Scholar 10 Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain, 6th ed. Chicago: American Pain Society2008. Google Scholar 11 : Does a smaller tract in percutaneous nephrolithotomy contribute to high renal pelvic pressure and postoperative fever?. J Endourol2008; 22: 2147. Google Scholar 12 : Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol2002; 168: 1348. Link, Google Scholar 13 : Pathophysiology of reno-ureteral colic. Urol Int2004; 72: 20. Google Scholar 14 : Complications in percutaneous nephrolithotomy. Eur Urol2007; 51: 899. Google Scholar 15 : Laparoscopic genitourinary surgery utilizing 20 mm Hg intra-abdominal pressure. J Laparoendosc Adv Surg Tech A1999; 9: 131. Google Scholar 16 : Measurement of renal pelvis pressures during endourologic procedures. Urology1987; 30: 472. Crossref, Medline, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byHarper J, Desai A, Maalouf N, Yang H, Antonelli J, Tasian G, Lai H, Reese P, Curatolo M, Kirkali Z, Al-Khalidi H, Wessells H, Scales C, Reese P, Tasian G, Ziemba J, Funsten E, Mussell A, McCune R, Shah S, Jain A, Selman-Fermin A, Maalouf N, Antonelli J, Johnson B, Pearle M, Baker L, Piskator B, Obiaro J, Rangel C, Hill M, Harper J, Wessells H, Curatolo M, Edwards T, Sorensen M, Sweet R, Baxter T, Covert H, Ayala E, Flint L, Cho G, Marshall G, Desai A, Lai H, Du K, Mueller S, Black L, Klim A, Scales C, Al-Khalidi H, Corneli A, Reeve B, Weinfurt K, Yang H, Andersen D, Johnson L, Dodd A, Thompson O, Dombeck C, McKenna K, Swezey T, Kirkali Z and Mullins C (2023) Risk Factors for Increased Stent-associated Symptoms Following Ureteroscopy for Urinary Stones: Results From STENTSJournal of Urology, Volume 199Issue 1January 2018Page: 193-199 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.Keywordskidney calculipercutaneousnephrostomypainpostoperative complicationsureteroscopypostoperativeMetricsAuthor Information Muhannad Alsyouf More articles by this author Samuel Abourbih More articles by this author Benjamin West More articles by this author Herbert Hodgson More articles by this author D. Duane Baldwin Financial interest and/or other relationship with DARRT Medical, Olympus, Bard and Cook Medical. More articles by this author Expand All Advertisement PDF downloadLoading ...