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<p>High intrarenal pressure (IRP) during retrograde intrarenal surgery (RIRS) is associated with postoperative complications such as sepsis. While lowering IRP by the use of ureteral access sheaths (UAS) with or without suction can reduce postoperative complications, data about the impact on stone-free rates (SFR) is limited. Our aim was to evaluate in a pilot study how variations in IRP correlate with SFR. Patients from March 1 and October 31, 2025 with a single renal stone ≥ 1&#xa0;cm or multiple stones who were randomized to RIRS with a standard or suctioning UAS. Continuous IRP monitoring was performed using the LithoVue™ Elite Single-Use Digital Flexible Ureteroscope System, with the operating surgeon blinded to the recorded values. Receiver Operating Characteristic (ROC) analyses, logistic regressions and Least Absolute Shrinkage and Selection Operator (LASSO) model were used to identify the most informative IRP metrics associated with achieving absolute SFR, defined as zero residual fragments on postoperative computed tomography scan. 20 patients underwent RIRS with a median stone burden of 12&#xa0;mm (IQR 12–18). The mean average IRP was 20.4 mmHg (SD 13.1). The mean proportions of treatment time with IRP &gt; 20 mmHg, &gt; 40 mmHg, and &gt; 60 mmHg were 52% (SD 23), 16% (SD 17), and 7% (SD 12) respectively, and absolute SFR was 69%. The proportion of treatment time with IRP &gt; 20 mmHg was the most discriminative metric to predict absolute SFR (AUC = 0.821, <i>p</i> = 0.028) with the strongest association based on logistic regression (OR = 1.074, <i>p</i> = 0.033) and LASSO modeling. Optimal thresholds to predict absolute SFR were at least 48% of treatment time &gt; 20 mmHg and average IRP of at least 16 mmHg. Proportion of treatment time with IRP greater than 40 or 60 mmHg did not confer better SFR. The use of suctioning UAS did not influence the effect of IRP on SFR. This pilot study demonstrated that excessively low IRP during RIRS with UAS may compromise procedural efficiency. The relative proportion of operative time with IRP &gt; 20 mmHg, but not &gt; 40 or &gt; 60 mmHg, is an exploratory example for a metric associated with SFR. Further studies are needed to validate our results and define the optimal IRP.</p>

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The effect of intrarenal pressure on Stone-Free rates in a pilot study: is there a desired range?

  • 期刊论文

  • 发表日期：

    2026年1月16日

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  • Ziv Savin,
  • Juan S. Serna,
  • Yuval Elkun,
  • Shrinkhala Kaphle,
  • William M. Atallah,
  • Mantu Gupta

摘要

High intrarenal pressure (IRP) during retrograde intrarenal surgery (RIRS) is associated with postoperative complications such as sepsis. While lowering IRP by the use of ureteral access sheaths (UAS) with or without suction can reduce postoperative complications, data about the impact on stone-free rates (SFR) is limited. Our aim was to evaluate in a pilot study how variations in IRP correlate with SFR. Patients from March 1 and October 31, 2025 with a single renal stone ≥ 1 cm or multiple stones who were randomized to RIRS with a standard or suctioning UAS. Continuous IRP monitoring was performed using the LithoVue™ Elite Single-Use Digital Flexible Ureteroscope System, with the operating surgeon blinded to the recorded values. Receiver Operating Characteristic (ROC) analyses, logistic regressions and Least Absolute Shrinkage and Selection Operator (LASSO) model were used to identify the most informative IRP metrics associated with achieving absolute SFR, defined as zero residual fragments on postoperative computed tomography scan. 20 patients underwent RIRS with a median stone burden of 12 mm (IQR 12–18). The mean average IRP was 20.4 mmHg (SD 13.1). The mean proportions of treatment time with IRP > 20 mmHg, > 40 mmHg, and > 60 mmHg were 52% (SD 23), 16% (SD 17), and 7% (SD 12) respectively, and absolute SFR was 69%. The proportion of treatment time with IRP > 20 mmHg was the most discriminative metric to predict absolute SFR (AUC = 0.821, p = 0.028) with the strongest association based on logistic regression (OR = 1.074, p = 0.033) and LASSO modeling. Optimal thresholds to predict absolute SFR were at least 48% of treatment time > 20 mmHg and average IRP of at least 16 mmHg. Proportion of treatment time with IRP greater than 40 or 60 mmHg did not confer better SFR. The use of suctioning UAS did not influence the effect of IRP on SFR. This pilot study demonstrated that excessively low IRP during RIRS with UAS may compromise procedural efficiency. The relative proportion of operative time with IRP > 20 mmHg, but not > 40 or > 60 mmHg, is an exploratory example for a metric associated with SFR. Further studies are needed to validate our results and define the optimal IRP.