Pressure-Controlled and Suction-Assisted Ureteroscopy: A Systematic Review and Meta-analysis of Fluid Dynamics and Perioperative Safety

Introduction Intrarenal Pressure (IRP) influences the safety of Ureteroscopy (URS) and Retrograde Intrarenal Surgery (RIRS), with excessive pressure potentially contributing to fluid absorption and infectious complications. This review evaluated the effects of pressure-modulating devices on fluid absorption, pressure dynamics, and perioperative outcomes in URS/RIRS. Methods A PRISMA-based systematic review was conducted and registered in PROSPERO (CRD420251238560). PubMed, Cochrane, and EBSCO were searched. Eligible studies were assessed using ROB 2 or the Newcastle–Ottawa Scale. Random-effects meta-analysis was performed for comparable outcomes. Results Four studies were included, comprising two randomized trials and two observational cohorts. Pressure-modulating systems significantly reduced fluid absorption (MD −159.71 mL; 95% CI −264.05 to −55.37; p = 0.003) and operative time (MD −22.93 min; 95% CI −45.28 to −0.58; p = 0.04). Postoperative fever was not significantly reduced (RD −0.05; 95% CI −0.18 to 0.08; p = 0.43). Discussion Pressure-modulating systems were associated with lower irrigation fluid absorption and shorter operative time. However, the reduction in postoperative fever was not statistically significant. Differences in devices, irrigation protocols, and pressure measurement methods may explain the variability between studies. Conclusion Available evidence suggests that intrarenal pressure–modulating devices enhance procedural safety during URS and RIRS by improving fluid dynamics without compromising treatment effectiveness. Further large-scale, multicenter trials are warranted to establish optimal pressure targets, harmonize outcome reporting, and clarify long-term clinical and economic implications.