Royal College of Surgeons in Ireland
BJU International - 2022 - Croghan - Upper urinary tract pressures in endourology a systematic review of range variables.pdf (263.82 kB)

Upper urinary tract pressures in endourology: a systematic review of range, variables and implications

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journal contribution
posted on 2022-11-11, 09:16 authored by Stefanie Croghan, Andreas Skolarikos, Gregory S Jack, Rustom P Manecksha, Michael T Walsh, Fergal O'BrienFergal O'Brien, Niall DavisNiall Davis

Objectives: To systematically review the literature to ascertain the upper tract pressures generated during endourology, the relevant influencing variables and clinical implications. 

Materials and Methods: A systematic review of the MEDLINE, Scopus and Cochrane databases was performed by two authors independently (S.C., N.D.). Studies reporting ureteric or intrarenal pressures (IRP) during semi-rigid ureteroscopy (URS)/flexible ureterorenoscopy (fURS)/percutaneous nephrolithotomy (PCNL)/miniaturized PCNL (mPCNL) in the period 1950–2021 were identified. Both in vitro and in vivo studies were considered for inclusion. Findings were independently screened for eligibility based on content, with disagreements resolved by author consensus. Data were assessed for bias and compiled based on predefined variables. 

Results: Fifty-two studies met the inclusion criteria. Mean IRP appeared to frequently exceed a previously proposed threshold of 40 cmH2O. Semi-rigid URS with low-pressure irrigation (gravity <1 m) resulted in a wide mean IRP range (lowest reported 6.9 cmH2O, highest mean 149.5 ± 6.2 cmH2O; animal models). The lowest mean observed with fURS without a ureteric access sheath (UAS) was 47.6 ± 4.1 cmH2O, with the maximum peak IRP being 557.4 cmH2O (in vivo human data). UAS placement significantly reduced IRP during fURS, but did not guarantee pressure control with hand-operated pump/syringe irrigation. Miniaturization of PCNL sheaths was associated with increased IRP; however, a wide mean human IRP range has been recorded with both mPCNL (lowest −6.8 ± 2.2 cmH2O [suction sheath]; highest 41.2 ± 5.3 cmH2O) and standard PCNL (lowest 6.5 cmH2O; highest 41.2 cmH2O). Use of continuous suction in mPCNL results in greater control of mean IRP, although short pressure peaks >40 cmH2O are not entirely prevented. Definitive conclusions are limited by heterogeneity in study design and results. Postoperative pain and pyrexia may be correlated with increased IRP, however, few in vivo studies correlate clinical outcome with measured IRP. 

Conclusions: Intrarenal pressure generated during upper tract endoscopy often exceeds 40 cmH2O. IRP is multifactorial in origin, with contributory variables discussed. Larger prospective human in vivo studies are required to further our understanding of IRP thresholds and clinical sequelae.


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The original article is available at

Published Citation

Croghan SM, et al. Upper urinary tract pressures in endourology: a systematic review of range, variables and implications. BJU Int. 2022

Publication Date

29 April 2022

PubMed ID



  • Beaumont Hospital
  • Tissue Engineering Research Group (TERG)
  • Anatomy and Regenerative Medicine

Research Area

  • Biomaterials and Regenerative Medicine
  • Chemistry and Pharmaceutical Sciences
  • Immunity, Infection and Inflammation




  • Published Version (Version of Record)