Endoluminal isoproterenol irrigation decreases renal pelvic pressure during flexible ureterorenoscopy: a clinical randomized, controlled study.
OBJECTIVE
Irrigation during ureterorenoscopic procedures causes increased pelvic pressure (PP), which may lead to intrarenal backflow with potential harmful consequences. This study aims to investigate PP response to intraluminal administration of isoproterenol (beta-agonist; ISO) during flexible ureterorenoscopy.


METHODS
Twelve patients admitted for retrograde intrarenal stone surgery (RIRS) were included. Patients were randomized to (1) irrigation with saline (n=6) or (2) irrigation with ISO 0.1 microg/mL (n=6). Irrigation rate was standardized to 8 mL/min. A ureteral catheter was retrogradely placed in the renal pelvis for PP measurements. PP, heart rate (HR), and mean arterial pressure (MAP) were also measured.


RESULTS
Baseline PP was 12.1+/-4mm Hg in the saline group and 10.3+/-4mm Hg in the ISO group (p=0.44). In the saline group, PP increased to a mean 33+/-12 mm Hg during ureterorenoscopy. In the ISO group, PP was a mean 19+/-3mm Hg (p=0.029). During endoscopy, PP peaks as high as 328 mm Hg were noted during saline irrigation. The number of pressure peaks above 50mm Hg was minimized dramatically during ISO irrigation (p=0.035). No systemic side effects to ISO irrigation were observed.


CONCLUSIONS
For the first time, a randomized, controlled human study demonstrates that pharmacologic modulation of the ureter is possible during upper urinary tract endoscopy. The ability to relax ureteral tone during endoscopy may have clinical advantages.
Jung
Helene
H
Department of Urology, Fredericia and Kolding Hospitals, Denmark. helene.jung@ki.au.dk
Nørby
Bettina
B
Frimodt-Møller
Poul Chr
PC
Osther
Palle Jörn
PJ
D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D006801:Humans; D007545:Isoproterenol / Q000494:pharmacology*; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000187:drug effects*; D011312:Pressure; D007507:Therapeutic Irrigation; D018666:Ureteroscopy
D000318:Adrenergic beta-Agonists; D007545:Isoproterenol