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Elevated intrarenal pressures (IRPs) during retrograde intrarenal surgery (RIRS) can cause serious complications. Strategies like managing irrigation flow and pressure can mitigate these risks, improving patient outcomes.

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Area of Science:

  • Urology
  • Nephrology
  • Surgical Technology

Background:

  • Elevated intrarenal pressures (IRPs) are a significant concern during retrograde intrarenal surgery (RIRS).
  • Understanding the complications associated with high IRPs is crucial for patient safety.

Purpose of the Study:

  • To review current evidence on complications arising from elevated IRPs during RIRS.
  • To identify and discuss strategies for mitigating IRP increases during RIRS.

Main Methods:

  • A comprehensive literature search was performed across PubMed, Web of Science, and EBSCO databases.
  • The study employed a narrative review methodology to analyze the gathered evidence.

Main Results:

  • Normal intrarenal pressure is 0-15 mmHg; however, RIRS often leads to dangerous elevations.
  • Complications include pyelorenal reflux (fever, urosepsis, pain) and forniceal rupture (bleeding, AKI, pain, fluid overload).
  • Mitigation strategies involve balancing inflow/outflow, controlling irrigation, using ureteral access sheaths, maintaining an empty bladder, and real-time IRP monitoring.

Conclusions:

  • Elevated IRPs during RIRS are linked to pyelorenal backflow and forniceal rupture.
  • Irrigation dynamics are key drivers of IRP.
  • Awareness and application of mitigation strategies can reduce RIRS complications and enhance patient outcomes.