{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:05:44Z","timestamp":1789567544048,"version":"build-2803163510"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Intrarenal pressure (IRP) plays a critical role in ensuring the safety of retrograde intrarenal surgery (RIRS), as elevated IRP is associated with complications such as pyelovenous backflow, infection, and renal injury. LithoVue\u2122 Elite (LVE) is the first commercially available ureteroscope (URS) capable of providing real-time IRP measurements. Conventionally, IRP has been measured via a percutaneous nephrostomy catheter (PNC), which may not accurately reflect dynamic changes during endoscopic procedures. Recently, small ureteral access sheaths (UASs) have been increasingly used to minimize ureteral injury risk. This study aimed (1) to assess the accuracy of LVE compared with that of IRP measured by a PNC and (2) to evaluate appropriate irrigation settings suitable for small UASs using porcine kidney models and LVE. Methods: An 11\/13-Fr UAS and a 10\/12-Fr UAS were inserted into each model, and an automatic irrigation pump (AIP) and hand pumping (HP) with a 20-cc syringe were used. IRP was measured at various LVE tip positions (renal pelvis and upper, middle, and lower calyces) with different irrigation settings, repeated four times in each. Simultaneously, the IRP via the PNC located in the upper calyx and renal pelvis was measured. Results: LVE showed high concordance with the PNC across the upper, middle, and lower calyces (p &gt; 0.05). However, at the renal pelvis, LVE measured IRP values that were significantly higher than the PNC by a mean of 1.93 \u00b1 0.93 mmHg (p &lt; 0.001). For the 11\/13-Fr UAS, the IRP remained below 30 mmHg across all irrigation settings with an AIP and HP. In contrast, the 10\/12-Fr UAS maintained 30 mmHg only with limited AIP settings, while HP resulted in high IRP, exceeding 100 mmHg at any location. Intergroup comparisons demonstrated that the IRP with the 10\/12-Fr UAS was significantly higher than that with the 11\/13-Fr UAS at any irrigation pressure setting across all URS tip positions (p &lt; 0.05). Intragroup comparisons indicated a significant pressure difference between the upper, middle, and lower calyces and the renal pelvis in both models at all irrigation settings (p &lt; 0.05). Conclusions: LVE provided accurate IRP measurements compared to the PNC. The IRP was significantly influenced by UAS size, irrigation setting, and URS tip position. When using small UASs, selecting appropriate irrigation settings is essential to maintain the safe threshold.<\/jats:p>","DOI":"10.3390\/jcm14103573","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T09:33:47Z","timestamp":1747733627000},"page":"3573","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Real-Time Measurement of Intrarenal Pressure Using LithoVue\u2122 Elite: Focus on Small Ureteral Access Sheaths and Appropriate Irrigation Settings"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2207-7119","authenticated-orcid":false,"given":"Naoto","family":"Tanaka","sequence":"first","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2911-2869","authenticated-orcid":false,"given":"Jose Carlo","family":"Elises","sequence":"additional","affiliation":[{"name":"Division of Urology, Philippine General Hospital, Manila 1000, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fukashi","family":"Yamamichi","sequence":"additional","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Kaku","sequence":"additional","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosuke","family":"Fukiishi","sequence":"additional","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaichiro","family":"Fujita","sequence":"additional","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6050-5452","authenticated-orcid":false,"given":"Takaaki","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Urology, Hara Genitourinary Hospital, Kobe City 650-0012, Hyogo, Japan"},{"name":"Division of Urology, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe City 650-0017, Hyogo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"999","DOI":"10.1097\/JU.0000000000001478","article-title":"Qualitative review of clinical guidelines for medical and surgical management of urolithiasis: Consensus and controversy 2020","volume":"205","author":"Jiang","year":"2021","journal-title":"J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zumstein, V., Betschart, P., Abt, D., Schmid, H.P., Panje, C.M., and Putora, P.M. (2018). Surgical management of urolithiasis\u2014A systematic analysis of available guidelines. BMC Urol., 18.","DOI":"10.1186\/s12894-018-0332-9"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1038\/nrurol.2015.271","article-title":"Use of ureteral access sheaths in ureteroscopy","volume":"13","author":"Kaplan","year":"2016","journal-title":"Nat. Rev. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1089\/end.2021.0868","article-title":"Routine use of ureteral access sheaths for ureteroscopy: Yay or nay?","volume":"36","author":"York","year":"2022","journal-title":"J. Endourol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s00345-018-2378-4","article-title":"Pressure matters: Intrarenal pressures during normal and pathological conditions, and impact of increased values to renal physiology","volume":"37","author":"Tokas","year":"2019","journal-title":"World J. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1089\/end.2014.0409","article-title":"Systemic inflammatory response syndrome after flexible ureteroscopic lithotripsy: A study of risk factors","volume":"29","author":"Zhong","year":"2015","journal-title":"J. Endourol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1186\/s40064-016-3383-y","article-title":"Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm","volume":"5","author":"Guzelburc","year":"2016","journal-title":"Springerplus"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1016\/S0022-5347(17)36456-X","article-title":"Morphological and physiological changes in the urinary tract associated with ureteral dilation and ureteropyeloscopy: An experimental study","volume":"149","author":"Schwalb","year":"1993","journal-title":"J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2675","DOI":"10.1007\/s00345-022-04154-5","article-title":"Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model","volume":"40","author":"Lee","year":"2022","journal-title":"World J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1001\/jama.1926.02680160035011","article-title":"Pyelovenous back flow","volume":"87","author":"Hinman","year":"1926","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1007\/BF00261587","article-title":"Intra-renal reflux","volume":"13","author":"Boccafoschi","year":"1985","journal-title":"Urol. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/bju.15764","article-title":"Upper urinary tract pressures in endourology: A systematic review of range, variables and implications","volume":"131","author":"Croghan","year":"2023","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/s00345-024-04815-7","article-title":"The optimal ratio of endoscope-sheath diameter with negative-pressure ureteral access sheath: An in vitro research","volume":"42","author":"Shi","year":"2024","journal-title":"World J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1007\/s00345-024-05125-8","article-title":"Intrarenal pressure and flow rate profile using LithoVue\u2122 elite: Impact of different irrigation systems and working channel instruments","volume":"42","author":"Vergamini","year":"2024","journal-title":"World J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1089\/end.2022.0841","article-title":"Intrarenal pressure measured using a novel flexible ureteroscope with pressure sensing capabilities: A study of the effects of ureteral access sheath, irrigation, and working channel accessories","volume":"37","author":"Chew","year":"2023","journal-title":"J. Endourol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1111\/bju.16173","article-title":"Retrospective first-in-human use of the LithoVue\u2122 Elite ureteroscope to measure intrarenal pressure","volume":"132","author":"Bhojani","year":"2023","journal-title":"BJU Int."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bai, J., Chi, Y., Shangguan, T., Lin, J., Ye, Y., Huang, J., Wen, Y., Liu, R., Chen, R., and Cai, W. (2024). Intrarenal pressure detection during flexible ureteroscopy with fiber optic pressure sensor system in porcine model. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-60080-z"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Yoshida, T., Tsuruoka, N., Haga, Y., Kinoshita, H., Lee, S.S., and Matsunaga, T. (2023). Automatic irrigation system with a fiber-optic pressure sensor regulating intrapelvic pressure for flexible ureteroscopy. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-47373-5"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1089\/end.2015.0387","article-title":"Can we provide low intrarenal pressures with good irrigation flow by decreasing the size of ureteral access sheaths?","volume":"30","author":"Sener","year":"2016","journal-title":"J. Endourol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.euf.2024.05.010","article-title":"Could use of a flexible and navigable suction ureteral access sheath be a potential game-changer in retrograde intrarenal surgery? Outcomes at 30 days from a large, prospective, multicenter, real-world study by the European Association of Urology Urolithiasis Section","volume":"10","author":"Gauhar","year":"2024","journal-title":"Eur. Urol. Focus"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.acuro.2023.09.001","article-title":"How to measure intra-renal pressure during flexible URS: Historical background, technological innovations and future perspectives","volume":"48","author":"Pauchard","year":"2024","journal-title":"Actas Urol. Esp."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1089\/end.2018.0774","article-title":"The effect of ratio of endoscope-sheath diameter on intrapelvic pressure during flexible ureteroscopic lasertripsy","volume":"33","author":"Fang","year":"2019","journal-title":"J. Endourol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.juro.2012.08.197","article-title":"Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery","volume":"189","author":"Traxer","year":"2013","journal-title":"J. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1089\/end.1990.4.135","article-title":"Intrarenal pressures generated during flexible deflectable ureterorenoscopy","volume":"4","author":"Wilson","year":"1990","journal-title":"J. Endourol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sierra, A., Corrales, M., Kolvatzis, M., Doizi, S., and Traxer, O. (2022). Real time intrarenal pressure control during flexible ureterorrenscopy using a vascular pressureWire: Pilot study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010147"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1007\/s00345-020-03259-z","article-title":"Characterization of intracalyceal pressure during ureteroscopy","volume":"39","author":"Patel","year":"2021","journal-title":"World J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s00345-023-04295-1","article-title":"The effect of irrigation rate on intrarenal pressure in an ex vivo porcine kidney model\u2014Preliminary study with different flexible ureteroscopes and ureteral access sheaths","volume":"41","author":"Guan","year":"2023","journal-title":"World J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Jung, G., Kho, Y., Park, J.S., Yuk, H.D., Ryang, S.H., and Cho, S.Y. (2022). Surgical parameters related to excessive intrarenal pressure during minimally invasive percutaneous nephrolithotomy in the supine position: A prospective observational clinical study. Biomed. Res. Int., 2022.","DOI":"10.1155\/2022\/1199052"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3573\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:35:52Z","timestamp":1760031352000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3573"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":28,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103573"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103573","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]}}}