Purpose: To estimate the effects of verapamil on pelvic pressure and investigate the possible systemic side effects in the porcine model during the procedure of increasing perfusion rates. Materials and Methods: In the experimental group, the pelvic pressure was recorded with increasing perfusion rates of the renal pelvis (0, 2, 4, 6, 8, 10, 14 and 20 ml/min) in response to intraluminal administration of increasing concentrations of verapamil (0, 0.1, 1, 10 and 100 µg/ml) in isotonic saline. In the isotonic saline group, the pressure flow study was also done by increasing perfusion rates of the renal pelvis per animal using isotonic saline without verapamil. Results: Perfusion with 1, 10 and 100 µg/ml verapamil caused a decrease in pelvic pressure as a response to increasing flow rates, whereas perfusion with 0.1 µg/ml verapamil did not obviously inhibit the increase of pelvic pressure at all perfusion rates compared with other concentrations. Importantly, the mean systolic blood pressure and mean heart rate were stable despite the increase of flow rates and verapamil concentrations. In the isotonic saline group, perfusion with isotonic saline resulted in an increase in the pelvic pressure with an increase in flow rates each time. Conclusions: Endoluminal administration of verapamil reduces pelvic pressure significantly without any untoward systemic cardiovascular side effects.

1.
Mensah-Dwumah M, Djurhuus JC, Constantinou CE: Hydronephrotic alterations in calyceal and renal pelvic pacemaker function of the in vitro pyeloureteral system. Urol Int 1980;35:161-166.
2.
Wilson WTPG: Intrarenal pressures generated during flexible deflectable ureterorenoscopy. J Endourol 1990;4:135-142.
3.
Mortensen J, Djurhuus JC: Hydrodynamics of the normal multicalyceal pyeloureter in pigs: the pelvic pressure response to increasing flow rates, its normal ranges and intraindividual variations. J Urol 1985;133:704-708.
4.
Mortensen J, Bisballe S, Jørgensen TM, et al: The normal pressure-flow relationship of pyeloureter in the pig. Urol Int 1982;37:68-72.
5.
Schwalb DM, Eshghi M, Davidian M, et al: Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: an experimental study. J Urol 1993;149:1576-1585.
6.
Jung HU, Frimodt-Møller PC, Osther PJ, et al: Pharmacological effect on pyeloureteric dynamics with a clinical perspective: a review of the literature. Urol Res 2006;34:341-350.
7.
Shao Y, Shen ZJ, Zhu YY, et al: Fluid-electrolyte and renal pelvic pressure changes during ureteroscopic lithotripsy. Minim Invasive Ther Allied Technol 2012;21:302-306.
8.
Zwergel UE, Zwergel TB, Neisius DA, et al: Effects of prostaglandin synthetase inhibitors on the upper urinary tract. Experimental studies on isolated preparations and urodynamic measurements in men. Urol Res 1990;18:429-433.
9.
Selmy GI, Hassouna MM, Khalaf IM, et al: Effects of verapamil, prostaglandin F2 alpha, phenylephrine, and noradrenaline on upper urinary tract dynamics. Urology 1994;43:31-35.
10.
Canda AE, Turna B, Cinar GM, et al: Physiology and pharmacology of the human ureter: basis for current and future treatments. Urol Int 2007;78:289-298.
11.
Holst U, Rawashdeh YF, Andreasen F, et al: Endoluminal pelvic perfusion with norepinephrine causes only minor systemic effects and diminishes the increase in pelvic pressure caused by perfusion. Scand J Urol Nephrol 2005;39:443-448.
12.
Tomiyama Y, Murakami M, Hayakawa K, et al: Pharmacological profile of KUL-7211, a selective beta-adrenoceptor agonist, in isolated ureteral smooth muscle. J Pharmacol Sci 2003;92:411-419.
13.
Holst U, Dissing T, Rawashdeh YF, et al: Norepinephrine inhibits the pelvic pressure increase in response to flow perfusion. J Urol 2003;170:268-271.
14.
Hauser DS, Mevissen M, Weiss R, et al: Effects of ketanserin and DOI on spontaneous and 5-HT-evoked peristalsis of the pig ureter in vivo. Br J Pharmacol 2002;135:1026-1032.
15.
Park YC, Tomiyama Y, Hayakawa K, et al: Existence of a beta3-adrenoceptro and its functional role in the human ureter. J Urol 2000;164:1364-1370.
16.
Wanajo I, Tomiyama Y, Yamazaki Y, et al: Ureteral selectivity of intravenous β-adrenoceptor agonists in pig model of acute ureteral obstruction: comparison of KUL-7211, a selective β2/β3 agonist, with isoproterenol, terbutaline, and CL-316243. Urology 2011;77:1266.e1-e6.
17.
Sarica K, Tanriverdi O, Aydin M, et al: Emergency ureteroscopic removal of ureteral calculi after first colic attack: is there any advantage? Urology 2011;78:516-520.
18.
Ames CD, Weld KJ, Dryer ST, et al: Pharmacologic manipulation of the porcine ureter: acute impact of topical drugs on ureteral diameter and peristaltic activity. J Endourol 2006;20:943-948.
19.
Wanajo I, Tomiyama Y, Yamazaki Y, et al: Pharmacological characterization of beta-adrenoceptor subtypes mediating relaxation in porcine isolated ureteral smooth muscle. J Urol 2004;172:1155-1159.
20.
Nguyen HT, Kogan BA: Renal hemodynamic changes after complete and partial unilateral ureteral obstruction in the fetal lamb. J Urol 1998;160(3 pt 2):1063-1069.
21.
Cybulski P, Honey RJ, Pace K: Fluid absorption during ureterorenoscopy. J Endourol 2004;18:739-742.
22.
Michel MS, Honeck P, Alken P: Conventional high pressure versus newly developed continuous-flow ureterorenoscope: urodynamic pressure evaluation of the renal pelvis and flow capacity. J Endourol 2008;22:1083-1085.
23.
Auge BK, Pietrow PK, Lallas CD, et al: Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol 2004;18:33-36.
24.
Jakobsen JS, Holst U, Jakobsen P, et al: Local and systemic effects of endoluminal pelvic perfusion of isoproterenol: a dose response investigation in pigs. J Urol 2007;177:1934-1938.
25.
Danuser H, Weiss R, Abel D, et al: Systemic and topical drug administration in the pig ureter: effect of phosphodiesterase inhibitors alpha1, beta and beta2-adrenergic receptor agonists and antagonists on the frequency and amplitude of ureteral contractions. J Urol 2001;166:714-720.
26.
Jung HU, Jakobsen JS, Mortensen J, et al: Irrigation with isoproterenol diminishes increases in pelvic pressure without side-effects during ureterorenoscopy: a randomized controlled study in a porcine model. Scand J Urol Nephrol 2008;42:7-11.
27.
Jung HU, Jakobsen JS, Frimodt-Moeller PC, et al: Irrigation with isoproterenol during ureterorenoscopy causes no systemic side-effects. Scand J Urol Nephrol 2008;42:158-163.
28.
Lovasz S, Romics I: Real-time flow resistance compensation for urodynamic examinations of the upper urinary tract through single lumen catheters. Int J Urol 2008;15:110-113.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.