The Evolving Role of IRP Monitoring in the Treatment and Management of Urinary Stones

In this Urology Times UroView program, Dr Michelle Semins and Dr Seth Bechis discuss the evolving significance of intra-renal pressure monitoring in treating urinary stones, noting the rising prevalence of stones, the various treatment options available, and the increasing preference for ureteroscopy due to technological advancements.

Seth Bechis, MD, discusses the rising use of ureteroscopy in treating urinary stones due to technological advancements, emphasizing its adaptability, improved imaging, and patient outcomes compared to other procedures, and shares an anecdote highlighting its benefits in terms of recovery and adaptability for patients' lifestyles.

Michelle Semins, MD, details the variability in intrarenal pressures, explaining that while a clear safe threshold is unknown, pressures over 30-40 might be dangerous; she lists factors influencing these pressures, like inflow/outflow and scope size, and mentions potential complications from prolonged high pressures, such as urosepsis.

Seth Bechis, MD, emphasizes the potential complications from elevated intra-renal pressure, such as sepsis from bacterial spread, ruptures leading to pain and difficult recovery, impaired renal function, and hemorrhage, highlighting the need for understanding these risks for better postoperative outcomes and hospital efficiency.

Dr Michelle Semins discusses strategies to minimize elevated intra-renal pressure, emphasizing the principle of ALARA (as low as reasonably achievable) by reducing inflow and increasing outflow, and suggesting tools and techniques such as stopcocks, gravity bags, ureter access sheaths, and new suction devices, while also highlighting the importance of controlling other risk factors like bacteria.

Drs Semins and Bechis discuss the utility and benefits of ureteral access sheaths, emphasizing their role in optimizing visualization, reducing intra-renal pressure, and potentially mitigating postoperative complications, while also noting the importance of size selection and highlighting emerging technologies that measure pressures and manage thermal injury.

Drs Bechis and Semins discuss their approaches to employing ureteral access sheaths, reviewing assessing the ureter's caliber, dilation techniques, and the potential need for stenting post-sheath use, considering patient history and logistical factors like on-call availability.

Experts converse on the evolving methods for real-time intra-renal pressure monitoring, its benefits in improving surgical procedures, and the potential for future automated adjustments based on the monitored data.

Drs Bechis and Semins discuss future developments in urinary stone management, emphasizing the potential for improved vacuum aspiration devices, combined intravenous and PCNL surgeries, and the hope for medications to dissolve stones.