ObjectiveTo characterise the effect of solitary and serial manual bolus irrigations on intrarenal pressures (IRPs) and observe the clinical consequences.Patients and MethodsA pressure guidewire was used for IRP measurement during routine flexible ureterorenoscopy for management of renal stone disease, including manual bolus irrigation when required to maintain vision. The fluid bolus was either as a solitary manual bolus or a series of manual boluses in quick succession. The pre‐bolus, maximal and difference between IRPs were calculated.ResultsA total of 50 procedures in 46 patients were analysed. In all, 68 solitary manual boluses and 38 serial manual boluses were observed to have been undertaken during these procedures. After a solitary manual bolus, the median (standard deviation [SD], range) increase in IRP was 22.4 (34.0, 0.1–160.8) mmHg, and the mean (SD, range) maximum IRP was 46.1 (41.7, 15.8–190.0) mmHg, with elevated IRPs persisting for a median (range) duration of 19 (4–66) s. After serial manual boluses, the median (SD, range) rise in IRP was 58.4 (64.7, 10.2–242.84) mmHg and the mean (SD, range) maximum IRP reached was 100.8 (69.7, 34.3–303.5) mmHg. The elevated IRPs endured for a median (range) of 42 (9–121 s; P < 0.01 in all comparisons), suggesting a much greater elevation of IRP with instances where serial bolus irrigation was undertaken.ConclusionsManual bolus irrigation, both solitary but particularly serial boluses, produces significant rises in IRP and could logically result in pyelovenous backflow and sepsis. We suggest that this manoeuvre should be avoided to reduce complications during ureterorenoscopy.

中文翻译：

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在输尿管软镜检查期间，连续手动推注冲洗会导致临界肾内压 - 是时候放弃这种操作了


目的描述单独和连续推注手动冲洗对肾内压 （IRP） 的影响并观察临床后果。患者和方法在常规输尿管软式肾镜检查期间使用压力导丝进行 IRP 测量，以治疗肾结石疾病，包括在需要时手动推注冲洗以保持视力。液体推注要么是单独的手动推注，要么是一系列快速连续的手动推注。计算 IRP 之间的推注前、最大值和差值。结果共分析了 46 例患者的 50 例手术。在这些手术中，总共观察到 68 次单独手动推注和 38 次连续手动推注。单独手动推注后，IRP 的中位（标准差 [SD]，范围）增加为 22.4 （34.0， 0.1–160.8） mmHg，平均 （SD，范围） 最大 IRP 为 46.1 （41.7， 15.8–190.0） mmHg，升高的 IRP 持续中位（范围）持续时间为 19 （4-66） 秒。连续手动推注后，IRP 的中位（SD，范围）升高为 58.4 （64.7， 10.2–242.84） mmHg，达到的平均值 （SD，范围） 最大 IRP 为 100.8 （69.7， 34.3–303.5） mmHg。升高的 IRP 持续了 42 （9-121 s;P < 0.01），表明在进行连续推注冲洗的情况下，IRP 的升高要高得多。结论手动推注冲洗，无论是单独推注还是连续推注，都会产生 IRP 的显着升高，并可能导致肾盂静脉回流和败血症。我们建议应避免这种操作，以减少输尿管肾镜检查期间的并发症。