BACKGROUND Intra-renal pressure (IRP) during endoscopic urological procedures, including flexible ureteroscopy (fURS), percutaneous nephrolithotomy (PCNL), and miniaturized PCNL, is increasingly recognized as a critical safety parameter. Elevated IRP may precipitate serious complications such as pyelovenous and pyelotubular backflow, urosepsis, forniceal rupture, and renal parenchymal injury. Although a general knowledge of increased intra renal pressure has been gaining prominence within urology there is no universal or acceptable standard for measuring IRP as well as safe pressure limits. AIM To systematically identify all available data on the measurement techniques of IRP, and all clinical outcomes that occur due to various degrees of pressure applied during an endourologic procedure, as well as complications that may arise when IRP reaches excessive levels. METHODS Using a systematic search, we searched PubMed/MEDLINE, EMBASE, Cochrane Library, and Scopus using the search terms listed above. Searches were limited to studies published through December 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines were followed. Studies measuring IRP during any endourologic procedure of the upper urinary tract were eligible. Two independent reviewers screened the literature, extracted data and assessed the risk of bias utilizing the Cochrane Risk of Bias tool version 2, Newcastle-Ottawa Scale, Murad Tool, and a customized checklist for in vitro research. A narrative synthesis was performed, grouped by measurement techniques, pressure ranges, and clinical outcomes. RESULTS Twenty-nine studies met inclusion criteria. IRP during fURS without a ureteral access sheath (UAS) frequently exceeded 40 cmH2O, with peak pressures reaching up to 437 cmH2O in human in vivo studies. UAS placement significantly reduced IRP across all measured parameters. In mini-PCNL, pressures ranged from 2.4 cmH2O to 39.7 cmH2O, with optimized sheath designs achieving lower pressures. Pyelovenous backflow was demonstrated at pressures ≥ 90 mmHg and pyelotubular backflow at ≥ 60 mmHg in porcine models. The most feared complication was urosepsis, with clinical studies demonstrating significantly higher IRP in patients who developed postoperative urosepsis (81.7 mmHg vs 38.5 mmHg, P < 0.001). Emerging technologies include ureteroscopes with integrated pressure monitoring (e.g. , LithoVue Elite) and novel non-invasive monitoring devices. CONCLUSION IRP monitoring during endourologic procedures is emerging as an essential component of patient safety. However, no universally agreed safe pressure threshold exists, and the commonly cited 30 mmHg limit is being challenged by newer evidence. Standardized measurement protocols, large prospective multicenter studies, and integration of real-time IRP monitoring into routine clinical practice are urgently needed.
BACKGROUND Benign prostatic hyperplasia commonly causes lower urinary tract symptoms and impaired quality of life (QoL). The International Prostate Symptom Score (IPSS), prostate volume (PV), and post-void residual (PVR) urine are routinely assessed together, but their correlations have not been comprehensively pooled. We hypothesized that symptom scores would correlate strongly with QoL but only moderately with anatomical and functional measures. AIM To determine pooled correlations between symptom scores, QoL, PV, and PVR urine in men with benign prostatic hyperplasia. METHODS PubMed, Scopus, Web of Science, and Lens.org were searched through December 2025. Eligible studies reported Pearson or Spearman correlation coefficients between the IPSS and QoL, PV, or PVR urine. Correlations were Fisher’s Z -transformed and pooled using restricted maximum likelihood random-effects meta-analysis. Heterogeneity, publication bias, subgroup patterns, and leave-one-out sensitivity were assessed. RESULTS Twenty-eight studies involving 4814 participants from 14 countries were included. The pooled correlation between the IPSS and QoL was strong [r = 0.713, 95% confidence interval (CI): 0.557-0.820; k = 5; I 2 = 3.26%; P < 0.001]. PV showed a moderate-to-large correlation with symptom severity (r = 0.457, 95%CI: 0.257-0.619; k = 12; I 2 = 38.37%; P < 0.001). PVR urine showed a moderate correlation with symptom severity (r = 0.363, 95%CI: 0.150-0.543; k = 11; I 2 = 51.18%; P = 0.001). No compelling publication bias was detected. CONCLUSION Symptom scores strongly reflect QoL impairment, whereas PV and PVR urine provide complementary, non-redundant clinical information.
BACKGROUND Extrinsic ureteral compression is an uncommon but clinically significant cause of obstructive uropathy. Iliac artery aneurysms rarely present with urinary tract obstruction and may be overlooked in the differential diagnosis of hydronephrosis, particularly in patients with underlying chronic kidney disease (CKD) in whom acute-on-chronic renal deterioration may develop rapidly. CASE SUMMARY A 63-year-old woman with hypertension, dyslipidemia, hypothyroidism, CKD, and coronary artery disease presented with pelvic pain, decreased oral intake, and vomiting. On admission, serum creatinine was 2.7 mg/dL, representing an acute rise of 1.1 mg/dL from a documented baseline of 1.6 mg/dL within the preceding seven days, fulfilling Kidney Disease: Improving Global Outcomes criteria for acute kidney injury superimposed on CKD. Noncontrast computed tomography (performed without intravenous contrast given the acute renal deterioration) revealed a large right common iliac artery aneurysm measuring 4.8 cm at its maximal diameter, compressing the right ureter at the pelvic brim with severe right-sided hydronephrosis and hydroureter. Percutaneous nephrostomy was performed, achieving successful decompression. Serum creatinine improved to 1.9 mg/dL by post-procedure day 4, establishing a new functional baseline. Multidisciplinary evaluation by urology, vascular surgery, nephrology, and cardiology was performed. Endovascular aneurysm repair was successfully carried out eight weeks after discharge, following cardiac optimization. The nephrostomy tube was removed twelve weeks after insertion, with serum creatinine stable at 1.8 mg/dL at three-month follow-up. CONCLUSION Common iliac artery aneurysm is a rare but important cause of obstructive uropathy and acute kidney injury superimposed on CKD. Early vascular imaging, prompt urinary decompression, and multidisciplinary coordination are essential to prevent irreversible renal impairment and to facilitate timely definitive aneurysm repair.
Chronic kidney disease (CKD) is a multifactorial condition in which urological comorbidities including recurrent urinary tract infections, obstructive uropathy, nephrolithiasis, and voiding dysfunction play a critical but often overlooked role in disease onset and progression. This mini-review aims to highlight the prevalence, clinical relevance, and impact of urological disorders in CKD, advocating for their systematic recognition and management within nephrology practice. A narrative synthesis of published literature was conducted, focusing on epidemiological data, clinical studies, and expert consensus addressing the intersection of CKD and urological comorbidities. Evidence indicates that urological disorders are common among CKD patients, particularly in the presence of diabetes mellitus, hypertension, and persistent proteinuria. These conditions accelerate renal decline, increase complications, and impair quality of life. Early detection and timely intervention, coupled with interdisciplinary collaboration between nephrologists and urologists, can delay disease progression and optimize patient outcomes. Integrating urological insights into nephrology care is essential to address the multifactorial nature of CKD. Routine screening for urological comorbidities, proactive management strategies, and closer interdisciplinary collaboration is recommended. Future research should quantify the benefits of such integrative approaches and explore innovative models of care to improve long-term outcomes.
Bladder diverticulum refers to an outpouching of the bladder wall. This condition can involve only the bladder mucosa or extend to include the entire lining of the bladder wall, including the muscles. Bladder diverticula can be congenital or acquired, affecting individuals of any sex or age. Congenital cases are more commonly seen in younger patients, while acquired cases typically affect adults. Patients may experience significant distress due to pain associated with recurrent infections or urinary tract symptoms. Diagnosis involves a combination of clinical evaluation and imaging studies. Over the years, management of bladder diverticula has evolved from non-surgical treatments to various surgical options, including open surgery and contemporary techniques such as laparoscopic or robotic-assisted surgical excision and endoscopic care. In longstanding cases or large diverticula, an open surgical approach may be particularly effective. It is crucial to address any underlying pathology in patients with acquired diverticula to prevent recurrence. This paper aims to review the literature on bladder diverticulum and its management, taking a practically-oriented approach that includes investigative and operative images for clarity and ease of understanding.
