Editorial comment: High pressure endoscopic irrigation: impact on renal histology

This is the authors' abstract. We don't add key points for this paper.

Flexible ureteroscopy for the management of proximal ureteral stones or kidney stones is a first line treatment modality according to European Association of Urology and American Urological Association guidelines (1, 2). Due to improvements in the surgical disposable devices, better quality and image resolution of analogical and digital flexible ureteroscopes, and high stone-free rates, RIRS indications are rapidly increasing (3). However, it is a procedure not free of complications and there is robust evidence that high intra-renal pressure used to improve surgical view is related to postoperative complications, such as peri--renal hematomas and infections (4, 5). Tokas et al. in a systematic review found that pyelovenous backflow may occur at pressure ranging from 13.6 ro 27.2 cmH2O and complications such as pyelorenal backflow, sepsis, and renal damage are directly related to increased intra-renal pressure (6). In the current paper, Loftus et al. ( Also, in this study, authors have demonstrated the ureteral access sheath (UAS) may prevent a significant increase in the intra-renal pressure, protecting the kidney of an eventual deleterious effects.