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World Journal of Clinical Urology
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2219-2816
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Meta-Analysis
Copyright: ©Author(s) 2026.
World J Clin Urol. Sep 16, 2026; 15(2): 123313
Published online Sep 16, 2026. doi: 10.5410/wjcu.123313
Table 1 Data extraction summary of included studies
Ref.
Study design
n
Procedure
IRP measurement method
Key IRP findings
Auge et al[17], 2004Prospective clinical5 patientsfURS ± UASNephrostomy tube + pressure transducerWithout UAS: 94.4 mmHg; with UAS: 40.6 mmHg
Nagele et al[18], 2007In vitro (porcine)Porcine kidneysMini-PCNLUrodynamic workstationConventional sheath: 136 cmH2O; new sheath: 20 cmH2O
Jung et al[19], 2008RCT12 patientsfURSUreteral catheter + pressure transducerSaline: 33 ± 12 mmHg; ISO: 19 ± 3 mmHg; peak: 328 mmHg
John et al[33], 2024In vivo porcine17 renal unitsfURSPressure-sensing guidewireMean IRP reduction: 29% (95%CI: 13%-53%)
Hong et al[8], 2023Ex vivo porcine21 renal unitsfURSPressure-sensing wirePyelotubular: ≥ 60 mmHg; pyelovenous: ≥ 90 mmHg
Doizi et al[23], 2021In vitro (silicone model)Kidney modelfURS, mini-PCNL, PCNLPressure transducerfURS: 1.4-46.2 cmH2O; mini-PCNL: 2.4-39.7 cmH2O; PCNL: 1.4-7.3 cmH2O
Patel et al[22], 2020Prospective clinical8 patients (45 calyces)fURSCardiac pressure guidewire12/14 Fr UAS lower pole: 49.2 ± 40.3 mmHg; 14/16 Fr: 16.2 ± 3.5 mmHg (P = 0.004)
Lazarus et al[26], 2022In vitro (phantom kidney)Phantom modelfURSFiber-optic pressure sensingTraditional 11/13 Fr: 20 mmHg; 12/14 Fr: 13 mmHg; novel UAS: 0 mmHg
Doizi et al[21], 2020Prospective pilot4 patients (5 procedures)fURSDigital pressure sensor wireBaseline: 6 cmH2O; f-URS: 63 cmH2O; laser mean: 115.3 cmH2O; peaks: 289-437 cmH2O
Sierra et al[27], 2022Prospective pilot20 patientsfURSVascular PressureWireBaseline: 13.6 cmH2O; laser + forced irrigation: 61.2 cmH2O; UTI: 15%
Jung and Osther[20], 2015Prospective clinical12 patientsfURSUreteral catheter + pressure transducerBaseline: 10 ± 4 mmHg; stone management: 54 ± 18 mmHg; peaks: 328 mmHg
Bhojani et al[28], 2023Retrospective observational50 patientsfURSLithoVue Elite (integrated sensor)Median IRP: 28.5 mmHg; max: 174 mmHg; < 60 mmHg for 92% of time
Chew et al[11], 2023In vivo porcine + bench validationPorcine + benchfURSLithoVue Elite (integrated sensor)No UAS: 64 mmHg; 11/13 Fr: 51 mmHg; 12/14 Fr: 39-40 mmHg; accuracy: 96%
Croghan et al[29], 2023Prospective multi-institutional120 patientsfURS + semi-rigid URSCOMET II pressure guidewireBaseline: 16.45 ± 5.99 mmHg; urosepsis IRP: 81.7 ± 49.52 vs controls 38.53 ± 22.6 (P < 0.001)
Yekani et al[32], 2023Prospective pilot10 patientsfURSNot 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], 2025In vitro (cadaveric porcine)Porcine kidneysfURSPressure transducer via ureteral catheterFANS + suction: 1.7 ± 0.6 cmH2O; conventional UAS + machine irrigation: 39.6 ± 0.8 cmH2O
Croghan et al[36], 2024RCT34 patientsfURSCOMET II pressure guidewirePB 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], 2025Retrospective observational25 patientsfURSLithoVue Elite (integrated sensor)Median IRP: 22.0 (15.0-36.5) mmHg; < 60 mmHg for 94.1% of time
Zhu et al[43], 2025Prospective clinical trial100 patientsfURSFANS with IRP monitoringIRP within 30 mmHg; operative time: 50.9 minutes vs 67.6 minutes (P < 0.01)
Yuen et al[42], 2025In vitro comparative validationBench modelfURSUrodynamic system (gold standard)LithoVue Elite: 0.26 ± 1.75 mmHg difference; ICC 0.975; all devices ICC > 0.915
Kayano et al[39], 2025Retrospective two-center30 patientsfURSLithoVue Elite (integrated sensor)% time > 30 mmHg: 3.31%; > 40 mmHg: 0.01%; 0% febrile UTI
Vergamini et al[35], 2024Ex vivo porcine252 experimentsfURSLithoVue 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], 2025In vitro bench-top validation30 paired measurementsfURSHandheld meter vs sphygmomanometerMean bias: 0.02 ± 0.35 mmHg; 95% limits: -0.664 to +0.704 mmHg; P = 0.756
Han et al[30], 2023Ex vivo porcine11 kidneysfURS6F 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], 2023Ex vivo porcine3 kidneysfURSPercutaneous catheterIRP drop: 42.30→24.45 mmHg with suction (P < 0.0001); paradoxical increase > 5 sec at > 200 mmHg
MacCraith et al[25], 2021Ex vivo porcinePorcine kidneysfURSPressure measurement system12/14F 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], 2021Ex vivo porcine (cadaveric)Porcine modelfURSArterial invasive pressure systemWith UAS: Bolus < 5 mL safe; without UAS: 2 mL bolus unsafe; 10/12 Fr UAS inadequate drainage
Samaras et al[34], 2024In vivo porcine3 pigsfURSZebraScope (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], 2025Ex vivo porcinePorcine kidneysfURSLithoVue 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.
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Table 2 Risk of bias assessment of included studies
Study type
Tool used
Overall assessment
RCTs (Jung et al[19], 2008, Croghan et al[36], 2024)ROB 2Low-moderate risk
Prospective clinical studiesNewcastle-Ottawa ScaleModerate-high quality
Retrospective studiesNewcastle-Ottawa ScaleModerate quality
Animal studiesCustomized checklistModerate risk
In vitro studiesCustomized checklistLow-moderate risk
Validation studiesCustomized checklistLow risk
RCTs: Randomized controlled trials; ROB 2: Cochrane Risk of Bias tool version 2.
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