Suction Use During Endourological Procedures
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ENDOUROLOGY (P MUCKSAVAGE AND B SOMANI, SECTION EDITORS)
Suction Use During Endourological Procedures Lazaros Tzelves 1
&
Andreas Skolarikos 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Equipment used in endourology is constantly evolving due to increasing incidence of urolithiasis. Suctioning has been used mainly in PCNL in conjunction with ultrasonic and ballistic devices for stone removal. Recently technological advances permitted the use of suctioning in more endourological techniques. This review aims to summarize the literature regarding these advancements and analyze the upcoming results. Recent Findings Several centers have conducted experimental and clinical studies on suctioning use during PCNL, mPCNL, and ureteroscopy and concluded that it is an effective and safe adjustment that improves stone-free rates and limits complication rates after these procedures. Summary Suctioning use during common endourological procedures led to improved safety and efficacy among several indications. Due to the observational nature and small sample size of many studies, larger RCTs are needed to make safe conclusions. Keywords Endourology . Urolithiasis . Ureteroscopy . Percutaneous nephrolithotripsy . Suctioning . Intrarenal pressure . Stone-free rate
Introduction Urolithiasis consists a major health problem worldwide, showing increasing trends [1]. New techniques and technological equipment have emerged and offer the urologist a great armamentarium to manage stone disease. Many years have passed since the introduction of flexible ureteroscopy (URS) by Marshall [2] and percutaneous nephrolithotomy (PCNL) by Fernstrom and Johansson [3]. Still, a basic unchanged component of these endoscopic procedures comprises the use of normal saline for irrigation. The latter is needed to enhance stone clearance, intraoperative visualization, and reduce thermal effect to tissues. High intrarenal pressure secondary to high perfusion rate of normal saline is linked to pyelovenous and pyelolymphatic backflow of fluids. This article is part of the Topical Collection on Endourology * Andreas Skolarikos [email protected] Lazaros Tzelves [email protected] 1
2nd Department of Urology, National and Kapodistrian University of Athens, Sismanogleion Hospital, Athens, Greece
This may result in systemic absorption of bacteria and their toxins [4] and occurrence of life-threatening sepsis after URS (0–4.5%) [5, 6••] and PCNL (0.3–9.3%) [7, 8]. Therefore efforts to control high renal pelvic pressure (RPP) led to the development of ureteral access sheaths (UAS) [9•] which ameliorate this phenomenon, but only partially. Suction in endourology is used for more than 25 years mainly combined with ultrasound and ballistic devices during PCNL to evacuate stone gravels more rapidly [10]. In the last 5 years, several centers have presented innovative UAS and PCNL sheaths or nephroscopes equipped with suctioning mechanisms. The purpose of this review is to summarize these latest advancements and
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