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Studies reporting ureteric or intrarenal pressures (IRP) during semi\u2010rigid ureteroscopy (URS)\/flexible ureterorenoscopy (fURS)\/percutaneous nephrolithotomy (PCNL)\/miniaturized PCNL (mPCNL) in the period 1950\u20132021 were identified. Both\n                      <jats:italic>in\u2009vitro<\/jats:italic>\n                      and\n                      <jats:italic>in\u2009vivo<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010two studies met the inclusion criteria. Mean IRP appeared to frequently exceed a previously proposed threshold of 40\u2009cmH\n                      <jats:sub>2<\/jats:sub>\n                      O. Semi\u2010rigid URS with low\u2010pressure irrigation (gravity &lt;1\u2009m) resulted in a wide mean IRP range (lowest reported 6.9 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O, highest mean 149.5\u2009\u00b1\u20096.2 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O; animal models). The lowest mean observed with fURS without a ureteric access sheath (UAS) was 47.6\u2009\u00b1\u20094.1 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O, with the maximum peak IRP being 557.4 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O (\n                      <jats:italic>in\u2009vivo<\/jats:italic>\n                      human data). UAS placement significantly reduced IRP during fURS, but did not guarantee pressure control with hand\u2010operated 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 \u22126.8\u2009\u00b1\u20092.2 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O [suction sheath]; highest 41.2\u2009\u00b1\u20095.3 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O) and standard PCNL (lowest 6.5 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O; highest 41.2 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O). Use of continuous suction in mPCNL results in greater control of mean IRP, although short pressure peaks &gt;40 cmH\n                      <jats:sub>2<\/jats:sub>\n                      O 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\n                      <jats:italic>in\u2009vivo<\/jats:italic>\n                      studies correlate clinical outcome with measured IRP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Intrarenal pressure generated during upper tract endoscopy often exceeds 40\u2009cmH\n                      <jats:sub>2<\/jats:sub>\n                      O. IRP is multifactorial in origin, with contributory variables discussed. Larger prospective human\n                      <jats:italic>in\u2009vivo<\/jats:italic>\n                      studies are required to further our understanding of IRP thresholds and clinical sequelae.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.15764","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T05:08:47Z","timestamp":1651208927000},"page":"267-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":74,"title":["Upper urinary tract pressures in endourology: a systematic review of range, variables and implications"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4524-3682","authenticated-orcid":false,"given":"Stefanie M.","family":"Croghan","sequence":"first","affiliation":[{"name":"Royal College of Surgeons  Dublin Ireland"},{"name":"Department of Urology Blackrock Clinic  Dublin 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