title: A Novel Flexible Ureteroscopy with Intelligent Control of Renal Pelvic Pressure: An Initial Experience of 93 Cases.
abstract: Flexible ureteroscopic lithotripsy (URS) is rapidly becoming a first-line therapy for patients with renal and ureteral calculi. Most current medical infusion devices can only monitor infusion flow and pressure, but not renal pelvic pressure (RPP).
  
  
  
  We designed a patented intelligent system to facilitate flexible URS that included an irrigation and suctioning platform and a ureteral access sheath (UAS) with a pressure-sensitive tip, enabling regulation of the infusion flow precisely and control of the vacuum suctioning by computerized real-time recording and monitoring of RPP. A stable RPP was ensured by pressure feedback technology. Ninety-three patients with renal or ureteral calculi participated in the study and received flexible URS. Gravel particles were sucked out automatically during the flexible URS. Patients were evaluated on postoperative days 1 and 30 by X-ray of kidneys, ureters, and bladder to assess stone-free status.
  
  
  
  In 81 of the 93 patients, only one surgery was needed to remove the stone. There were nine cases who failed the first surgery due to difficulty in placing the UAS, but flexible URS was performed in these patients after indwelling a Double-J stent to the ureter with the calculus for 2 weeks. Three cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. For the 90 patients who underwent flexible URS, the actual RPP was controlled under 20 mmHg with clear operative visualization. The stone-free rates at postoperative days 1 and 30 were 90.0% (81/90) and 95.6% (86/90), respectively. Clavien I complications were noted in 13 cases, while Clavien II complications were noted in two cases. No major complications (Clavien III-V) were noted.
  
  
  
  Our patented system is technically feasible, safe, and efficient for treating upper urinary calculi. The advantages include breaking stones effectively and low complication rates because of its automatic control of RPP.
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Xiaolin
authors: X
authors: Deng
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Leming
authors: L
authors: Song
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Donghua
authors: D
authors: Xie
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Difu
authors: D
authors: Fan
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Lunfeng
authors: L
authors: Zhu
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Lei
authors: L
authors: Yao
authors: 2 Department of Urology, The Chinese Traditional Medicine Hospital of Pinghu City , Ping Hu, China .
authors: Xiaolin
authors: X
authors: Wang
authors: 3 The Chinese Traditional Medicine Hospital of Ganzhou City , Ganzhou, China .
authors: Shaohua
authors: S
authors: Liu
authors: 4 The second People's Hospital of Nankang District , Ganzhou, China .
authors: Yonghua
authors: Y
authors: Zhang
authors: 5 Gan County Dermatology Institute , Gan County, China .
authors: Xiaohui
authors: X
authors: Liao
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Shengfeng
authors: S
authors: Liu
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Zuofeng
authors: Z
authors: Peng
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Min
authors: M
authors: Hu
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Xianxin
authors: X
authors: Zhu
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Jianrong
authors: J
authors: Huang
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Tairong
authors: T
authors: Liu
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Chuance
authors: C
authors: Du
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Shulin
authors: S
authors: Guo
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Zhongsheng
authors: Z
authors: Yang
authors: 1 Department of Urology, The Affiliated Ganzhou Hospital of Nanchang University , Ganzhou, China .
authors: Guanghua
authors: G
authors: Peng
authors: 6 Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China .
authors: Zhangqun
authors: Z
authors: Ye
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods; D011312:Pressure; D012189:Retrospective Studies; D015607:Stents; D013396:Suction; D016896:Treatment Outcome; D014513:Ureter; D014514:Ureteral Calculi / Q000601:surgery*; D020709:Ureteroscopes; D018666:Ureteroscopy; D055815:Young Adult
keywords: equipment; pressure feedback; renal calculi; renal pelvic pressure control