Comparison of Two Fluid-Management Platforms for Flexible Ureteroscopy in Renal Stone Treatment: Pressure-Feedback Irrigation and Aspiration Versus a Suction Access Sheath Without Pressure Feedback

Background/Objectives: In the modern treatment of renal stones, intrarenal pressure management is an important safety factor in flexible ureteroscopy. Modern techniques that include real-time monitoring of intrarenal pressure, continuous irrigation, and controlled aspiration can improve intraoperative visibility while reducing the risk of problems associated with increased pressure. Methods: A retrospective comparative observational study was performed on 120 consecutive eligible patients with single pyelocaliceal renal stones and a negative preoperative urine culture. Group 1 included 55 patients treated with the ClearPetra® 10/12 Fr. suction access sheath, without intrarenal pressure monitoring. Group 2 included 65 patients treated with the Elephant IV 10/12 Fr. sheath associated with the Tidor™ device, which allows intrarenal pressure monitoring and automatic control of irrigation and aspiration. In Group 2, the intrarenal pressure limit was set at 30 mmHg. Access sheath insertion was possible in all cases. Results: The mean operative time was significantly shorter in Group 2 than in Group 1 (35.9 ± 11.3 versus 53.7 ± 7.7 min, p < 0.001). After adjustment for maximum stone diameter, stone density, and stone location, the Elephant IV + Tidor™ platform remained associated with shorter operative time (adjusted mean difference, −17.4 min; 95% CI, −21.8 to −12.9; p < 0.001). In Group 2, intrarenal pressure was maintained between 5 and 17 mmHg. At 30 days, the stone-free rate was numerically higher in Group 2 (96.9% versus 90.9%), while mean hospital stay (1.02 versus 1.09 days, p = 0.077), postoperative JJ-stent placement (4.6% versus 12.7%), and minor complications (4.6% versus 12.7%) were numerically lower; these differences did not reach statistical significance. Conclusions: The Elephant IV + Tidor™ system was feasible and maintained measured intrarenal pressure within a low range during RIRS, while being associated with a significantly shorter operative time. Differences in the other postoperative outcomes should be interpreted as exploratory numerical trends.