Intrarenal pressure during endourologic stone surgery: A systematic review of measurement, clinical impact, and pressure-control strategies

Table 1 Data extraction summary of included studies

Ref.	Study design	n	Procedure	IRP measurement method	Key IRP findings
Auge et al[17], 2004	Prospective clinical	5 patients	fURS ± UAS	Nephrostomy tube + pressure transducer	Without UAS: 94.4 mmHg; with UAS: 40.6 mmHg
Nagele et al[18], 2007	In vitro (porcine)	Porcine kidneys	Mini-PCNL	Urodynamic workstation	Conventional sheath: 136 cmH2O; new sheath: 20 cmH2O
Jung et al[19], 2008	RCT	12 patients	fURS	Ureteral catheter + pressure transducer	Saline: 33 ± 12 mmHg; ISO: 19 ± 3 mmHg; peak: 328 mmHg
John et al[33], 2024	In vivo porcine	17 renal units	fURS	Pressure-sensing guidewire	Mean IRP reduction: 29% (95%CI: 13%-53%)
Hong et al[8], 2023	Ex vivo porcine	21 renal units	fURS	Pressure-sensing wire	Pyelotubular: ≥ 60 mmHg; pyelovenous: ≥ 90 mmHg
Doizi et al[23], 2021	In vitro (silicone model)	Kidney model	fURS, mini-PCNL, PCNL	Pressure transducer	fURS: 1.4-46.2 cmH2O; mini-PCNL: 2.4-39.7 cmH2O; PCNL: 1.4-7.3 cmH2O
Patel et al[22], 2020	Prospective clinical	8 patients (45 calyces)	fURS	Cardiac pressure guidewire	12/14 Fr UAS lower pole: 49.2 ± 40.3 mmHg; 14/16 Fr: 16.2 ± 3.5 mmHg (P = 0.004)
Lazarus et al[26], 2022	In vitro (phantom kidney)	Phantom model	fURS	Fiber-optic pressure sensing	Traditional 11/13 Fr: 20 mmHg; 12/14 Fr: 13 mmHg; novel UAS: 0 mmHg
Doizi et al[21], 2020	Prospective pilot	4 patients (5 procedures)	fURS	Digital pressure sensor wire	Baseline: 6 cmH2O; f-URS: 63 cmH2O; laser mean: 115.3 cmH2O; peaks: 289-437 cmH2O
Sierra et al[27], 2022	Prospective pilot	20 patients	fURS	Vascular PressureWire	Baseline: 13.6 cmH2O; laser + forced irrigation: 61.2 cmH2O; UTI: 15%
Jung and Osther[20], 2015	Prospective clinical	12 patients	fURS	Ureteral catheter + pressure transducer	Baseline: 10 ± 4 mmHg; stone management: 54 ± 18 mmHg; peaks: 328 mmHg
Bhojani et al[28], 2023	Retrospective observational	50 patients	fURS	LithoVue Elite (integrated sensor)	Median IRP: 28.5 mmHg; max: 174 mmHg; < 60 mmHg for 92% of time
Chew et al[11], 2023	In vivo porcine + bench validation	Porcine + bench	fURS	LithoVue Elite (integrated sensor)	No UAS: 64 mmHg; 11/13 Fr: 51 mmHg; 12/14 Fr: 39-40 mmHg; accuracy: 96%
Croghan et al[29], 2023	Prospective multi-institutional	120 patients	fURS + semi-rigid URS	COMET II pressure guidewire	Baseline: 16.45 ± 5.99 mmHg; urosepsis IRP: 81.7 ± 49.52 vs controls 38.53 ± 22.6 (P < 0.001)
Yekani et al[32], 2023	Prospective pilot	10 patients	fURS	Not specified (syphon UAS study)	Without syphon: Baseline 29 mmHg, peak bolus 104 mmHg; with syphon: Baseline 18 mmHg (P < 0.001), peak bolus 71 mmHg (P = 0.03)
Gadzhiev et al[38], 2025	In vitro (cadaveric porcine)	Porcine kidneys	fURS	Pressure transducer via ureteral catheter	FANS + suction: 1.7 ± 0.6 cmH2O; conventional UAS + machine irrigation: 39.6 ± 0.8 cmH2O
Croghan et al[36], 2024	RCT	34 patients	fURS	COMET II pressure guidewire	PB mean: 38.16 ± 16.84 mmHg; HP mean: 62.29 ± 27.45 mmHg (P = 0.005); PB max: 68.04 mmHg; HP max: 192.71 mmHg (P < 0.001)
Chen et al[37], 2025	Retrospective observational	25 patients	fURS	LithoVue Elite (integrated sensor)	Median IRP: 22.0 (15.0-36.5) mmHg; < 60 mmHg for 94.1% of time
Zhu et al[43], 2025	Prospective clinical trial	100 patients	fURS	FANS with IRP monitoring	IRP within 30 mmHg; operative time: 50.9 minutes vs 67.6 minutes (P < 0.01)
Yuen et al[42], 2025	In vitro comparative validation	Bench model	fURS	Urodynamic system (gold standard)	LithoVue Elite: 0.26 ± 1.75 mmHg difference; ICC 0.975; all devices ICC > 0.915
Kayano et al[39], 2025	Retrospective two-center	30 patients	fURS	LithoVue Elite (integrated sensor)	% time > 30 mmHg: 3.31%; > 40 mmHg: 0.01%; 0% febrile UTI
Vergamini et al[35], 2024	Ex vivo porcine	252 experiments	fURS	LithoVue Elite (integrated sensor)	SAPS higher IRP/FR than pumps (P < 0.01); larger UAS → lower IRP (P < 0.01); rho > 0.9
Omar et al[40], 2025	In vitro bench-top validation	30 paired measurements	fURS	Handheld meter vs sphygmomanometer	Mean bias: 0.02 ± 0.35 mmHg; 95% limits: -0.664 to +0.704 mmHg; P = 0.756
Han et al[30], 2023	Ex vivo porcine	11 kidneys	fURS	6F pressure catheters (upper/lower calyces)	cUAS: IRP 30 mmHg at 60-70 cc/minute; vaUAS: IRP < 10 mmHg up to 120 cc/minute; Backflow at 40 mmHg
Ostergar et al[31], 2023	Ex vivo porcine	3 kidneys	fURS	Percutaneous catheter	IRP drop: 42.30→24.45 mmHg with suction (P < 0.0001); paradoxical increase > 5 sec at > 200 mmHg
MacCraith et al[25], 2021	Ex vivo porcine	Porcine kidneys	fURS	Pressure measurement system	12/14F UAS: 16.45 ± 5.3 cmH2O; 11/13 F: 32.73 ± 35.66 cmH2O (P = 0.006); safest: 11.6 ± 3.65 cmH2O; most dangerous: 100.6 ± 16.1 cmH2O
Lazarus et al[24], 2021	Ex vivo porcine (cadaveric)	Porcine model	fURS	Arterial invasive pressure system	With UAS: Bolus < 5 mL safe; without UAS: 2 mL bolus unsafe; 10/12 Fr UAS inadequate drainage
Samaras et al[34], 2024	In vivo porcine	3 pigs	fURS	ZebraScope (integrated sensor)	No UAS: 28.25 ± 11.2 mmHg to 35.46 ± 10.08 mmHg; 12/14 Fr UAS: 7.64 ± 3.08 mmHg to 9.25 ± 1.42 mmHg
Tanaka et al[41], 2025	Ex vivo porcine	Porcine kidneys	fURS	LithoVue Elite vs PNC (gold standard)	11/13 Fr UAS: < 30 mmHg all settings; 10/12 Fr UAS: HP > 100 mmHg; LVE accurate vs PNC (P > 0.05 for calyces)

IRP: Intrarenal pressure; fURS: Flexible ureteroscopy; UAS: Ureteral access sheath; RCT: Randomized controlled trial; PCNL: Percutaneous nephrolithotomy; Mini-PCNL: Mini-percutaneous nephrolithotomy; FANS: Flexible and Navigable Suction Ureteral Access Sheath; UTI: Urinary tract infection; ISO: Isoproterenol; ICC: Intraclass correlation coefficient; PNC: Percutaneous nephrostomy catheter; SAPS: Sterile automated pressure system; FR: Flow rate; HP: Hand-pump irrigation; PB: Pressurized-bag irrigation.