Current utility, instruments, and future directions for intra-renal pressure management during ureteroscopy: scoping review by global research in intra-renal pressure collaborative group initiative
Bibliographic record
Abstract
Background: Technical advancements and intrarenal pressure are synergistic in improving perioperative outcomes during flexible ureteroscopy (FURS). Mismanaged intra-renal pressure (IRP) has negative consequences and it is associated with an increased risk of sepsis, bleeding, pelvicalyceal fluid extravasation, and even collecting system injuries and acute as well as chronic renal failure. The cornerstone of a safe FURS is the ability to continuously monitor IRP to avoid elevation of IRP above the normal range of 10 mmHg. Objectives: This scoping review aims to report the current state of real-time IRP monitoring in in vivo clinical studies and the various monitoring methods and technology to understand how this may be best used in daily clinical practice. Eligibility criteria: A systematic literature search was conducted. Only in vivo clinical studies published in English documenting IRP measurement methodologies during semirigid or flexible ureteroscopy for urolithiasis management were included. Results: Out of 1326 retrieved papers, 17 studies met the inclusion criteria, comprising 2 randomized controlled trials, 2 retrospective studies, and 13 observational studies. Current noninvasive IRP monitoring devices include ureteric catheters placed retrogradely or via percutaneous tubing and connected to pressure transducers, amplified by cardiology-used pressure sensing systems or urodynamic systems, automated pressure-regulating systems, pressure sensing guidewires, and IRP sensing flexible ureteroscopes. The review revealed significant variations in IRP measurement methods, reporting units, and irrigation techniques. Notably, elevated IRP above 30 mmHg was consistently associated with increased postoperative complications, including sepsis. Conclusion: Current clinical studies have only ascertained that increased IRP above 40 mmHg positively correlates with infectious complications and postoperative pain. No standardized values are available to predefine safe thresholds in practice. With the availability of noninvasive tools for IRP monitoring, future research should focus on multicenter studies to establish reference ranges and best practices for IRP management, ultimately improving patient outcomes in endourological procedures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".