Novel devices for intrarenal pressure monitoring: are they the future?

PURPOSE OF REVIEW: Elevated intrarenal pressure (IRP) during flexible ureteroscopy (fURS) and retrograde intrarenal surgery (RIRS) is increasingly recognized as a key driver of infectious and inflammatory complications. Novel devices integrating real-time pressure monitoring and active suction have been developed to address this modifiable risk factor. This review evaluates emerging intelligent pressure-controlled systems and examines whether they represent the future standard in endourological practice. RECENT FINDINGS: Intelligent pressure-controlled ureteral access sheaths (IPC-UAS) and related suction-assisted platforms incorporate continuous IRP sensing with automated feedback mechanisms to maintain renal pelvic pressure within predefined safety thresholds. Observational studies report stone-free rates ranging from 80% to 96%, comparable to or exceeding conventional fURS and, in selected cases, minimally invasive percutaneous nephrolithotomy. Importantly, postoperative fever and sepsis rates appear consistently reduced, with several large series reporting near-zero sepsis incidence. Additional benefits include improved visualization, enhanced fragment clearance, shorter hospitalization, and potential expansion of ureteroscopic indications to larger stones and high-risk populations such as solitary kidneys or infection-prone patients. SUMMARY: Current evidence, although predominantly retrospective, suggests that real-time IRP monitoring and automated pressure control improve safety without compromising efficacy. Standardization of measurement techniques and high-quality randomized trials are required to confirm clinical benefit and cost-effectiveness. Nevertheless, intelligent pressure-regulated systems align with the broader evolution toward data-driven, feedback-controlled endourology and may represent an important step toward safer intrarenal surgery.