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Experimental and clinical studies: a scoping review of intrarenal pressure in percutaneous nephrolithotomy
Carlo Giulioni1, Daniele Castellani2,3, Angelo Cafarelli4
1Department of Urology, Casa di Cura Villa Igea, Ancona, 60127, Italy. carlo.giulioni9@gmail.com.
Purpose:
Intrarenal pressure (IRP) plays a critical role in the safety of percutaneous nephrolithotomy (PCNL), with elevated pressures associated with inflammatory and infectious complications. This scoping review aims to synthesize experimental and clinical evidence on factors influencing IRP during PCNL and to evaluate the impact of contemporary techniques and adjunctive technologies on pressure control and clinical outcomes.
Methods:
A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Embase, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to July 2025. Experimental and clinical studies assessing IRP during standard, miniaturized, and suction-assisted PCNL were included. Primary outcomes were mean and peak IRP and determinants of pressure variation. Secondary outcomes included the stone-free rate (SFR) and pressure-related complications.
Results:
Thirty-five studies (13 experimental and 22 clinical) were included. Across all models, IRP was highly sensitive to irrigation modality, tract size, outflow patency, and suction use. Miniaturized PCNL systems consistently generated higher and more variable IRP due to restricted passive drainage. Gravity-fed irrigation maintained lower and more stable pressures than pressurized systems. Suction-assisted sheaths and pressure-regulated platforms significantly reduced mean and peak IRP, limited pressure fluctuations, and shortened the duration of exposure to unsafe pressure levels. Importantly, suction-assisted PCNL achieved equal or superior SFR compared with non-suction techniques.
Conclusion:
IRP is a pivotal and modifiable element of PCNL safety. Suction-assisted and pressure-regulated technologies effectively mitigate IRP elevations without compromising efficacy. Standardization of IRP monitoring and the definition of clinically meaningful pressure thresholds are necessary to optimize future PCNL practice.