To evaluate the educational validity of two bench-top simulators for Transurethral Resection of the Prostate (TURP) and Transurethral Resection of Bladder Tumor (TURB), focusing on their realism, ergonomics, and relevance for structured endourology training. Fourteen expert endourologists from multiple European centers assessed both simulators during the European Association of Urology Residents Education Programme (EUREP) 2025. Face validity and content validity were evaluated using 4-point Likert questionnaires. Item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices were calculated for all items and adjusted for core procedural skills. Experts rated both simulators highly for anatomical realism, tissue handling, and overall utility (mean scores > 3.5/4). The TURP simulator achieved an adjusted S-CVI/Ave of 0.92 and the TURB simulator 0.97, indicating excellent consensus on their educational adequacy for key procedural steps. Non-modeled features such as bleeding, obturator reflex, and energy modulation received low ratings, reflecting inherent limitations of bench-top simulation. Both models were considered effective for practicing instrument handling and resection depth control in a risk-free, standardized environment. The TURP and TURB simulators demonstrated strong face and content validity for core resection training. Their modular, non-biological, and reproducible design supports safe, structured skill acquisition and competency assessment in endourology curricula, offering a practical bridge between theoretical learning and clinical performance.

Objective:To evaluate the perioperative outcomes of suction mini-percutaneous nephrolithotomy (SM-PCNL) using disposable versus reusable sheaths, based on data from the global Suction Technology Utility in Mini-Percutaneous nephrolithotomy Study (STUMPS) registry. Methods:This prospective, multicenter observational study analyzed adult patients undergoing SM-PCNL using either disposable or reusable suction sheaths (14-22 Fr) between March 2024 and November 2024 across 30 centers in 21 countries. Propensity score matching was employed to balance key variables, including age, sex, Guy's stone score, stone volume, and patient position. Primary outcomes included 30-day stone-free rates, complications, and operative metrics. Multivariable logistic regression was performed to identify predictors of complete (Grade A) stone clearance. Results:Among 1524 patients, 1024 were matched for analysis (512 in each group). Both groups had comparable distributions of 30-day postoperative residual fragment grades (p=0.90), with similar stone-free rates (Grade A clearance: 80% in the reusable group vs. 81% in the disposable group). The disposable group demonstrated a significantly lower 30-day complication rate (9.4% vs. 15%; p=0.01), including fewer renal pelvic injuries and bleeding events. However, operative time was longer in this group (median 50 min vs. 44 min; p=0.02), and the reintervention rate was higher (3.3% vs. 1.0%; p=0.02). Predictors of reduced stone clearance included supine positioning, smaller sheath size, and larger stone volume. Conclusion:Both disposable and reusable sheaths yield comparable stone clearance in SM-PCNL. However, disposable sheaths are associated with fewer complications and may offer practical advantages in settings with limited reprocessing capabilities. Further randomized trials and cost-effectiveness studies are warranted to guide sheath selection in diverse clinical environments.

Ureteral stents are widely used following ureteroscopy (URS), yet several aspects of their management remain non-standardized despite contemporary EAU and AUA guideline recommendations. This study evaluated contemporary international practices and identified gaps in ureteral stent use among endourologists. A cross-sectional international survey consisting of 58 items across nine domains was distributed via social media, major urological meetings, and the EAU Endourology Section. Only fully completed responses were analyzed. Descriptive statistics were used, with continuous variables reported as medians and categorical variables as frequencies and percentages. A total of 121 respondents from 48 countries were included. Stent placement remained common after uncomplicated ureteroscopy and was nearly universal in complicated cases. Pre-stenting was applied selectively, most commonly after failed ureteroscopy and for ureteral dilatation. A 6 Fr stent and polyurethane material were the preferred choices. Stent-related symptoms were frequent, with urgency and frequency predominating, followed by hematuria. Pharmacologic management varied, and conservative treatment was commonly used for post-stenting infections. Notably, 45

The landscape of flexible ureteroscopy (fURS) is evolving with the use of flexible and navigable suction ureteral access sheaths (FANS) as surgeons gain experience utilizing suction. Surveys offer a unique lens through which to evaluate the adoption, efficacy, and challenges associated with new endourology technology. As FANS become widespread, we aimed to capture real-world practice patterns of FANS utilization in fURS. A collaborative effort by the European Association of Urology (EAU), Progressive Endourological Association for Research and Leading Solutions (PEARLS) and International Alliance of Urolithiasis (IAU) lead to the design and dissemination of a 41-question survey via SurveyMonkey and social media from 19 April to 29 May 2025. Participation was voluntary. Descriptive statistics were applied to demographic details and categorical responses. A total of 680 participants had completed the questionnaire. The majority of respondents were endourology fellowship-trained consultants (71.8

Accurate assessment of stone burden is fundamental in urolithiasis, as it directly influences treatment selection and prognostic evaluation. Although maximum stone diameter on non-contrast computed tomography remains the most widely used parameter, it does not adequately reflect the three-dimensional complexity of urinary calculi. This review aimed to summarize the evolution of stone burden assessment from conventional imaging-based methods to software-assisted volumetry and artificial intelligence (AI)-driven tools, with emphasis on their accuracy, reproducibility, and clinical utility. A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Google Scholar for English-language studies published up to March 2026. Original studies, validation studies, technical reports, reviews, and guideline-related papers addressing conventional CT-based measurement, software-assisted volumetry, AI-based stone segmentation, and the clinical significance of stone volume were included. Due to heterogeneity in study design and reported outcomes, the evidence was synthesized narratively. Maximum stone diameter remains simple and widely available, but it incompletely represents true stone burden, particularly in larger or irregular stones. Formula-based ellipsoid calculations are practical yet show limited accuracy in complex geometries. Semi-automated CT-based segmentation software provides more reliable volumetric assessment, with excellent agreement with reference standards and reduced interobserver variability. AI-based approaches have further improved efficiency by enabling rapid and highly accurate automated stone detection and volume calculation. Across the reviewed literature, stone volume was consistently shown to be more clinically informative than linear dimensions for predicting spontaneous passage, stone-free rates after shockwave lithotripsy and ureteroscopy, and future symptomatic events during surveillance. Stone volume offers a more accurate and clinically meaningful estimate of stone burden than maximum stone diameter alone. The transition from formula-based methods to software-assisted and AI-driven volumetry represents an important advance in urolithiasis imaging. Wider adoption will depend on standardized imaging protocols, improved software accessibility, and validation of volume-based thresholds for routine clinical practice.

Background and ObjectiveMinimally invasive surgical therapies (MISTs) have emerged as alternative treatment options for benign prostatic obstruction (BPO), aiming to reduce morbidity while preserving functional outcomes. However, their adoption in routine clinical practice remains heterogeneous. We evaluated urologists’ perspectives on the utilization, perceived efficacy, barriers, and future role of MISTs in BPO management.MethodsA prospective, cross-sectional, web-based survey was conducted among members of the Young Academic Urologists (YAU) and the European Association of Urology (EAU) Endourology Section. The questionnaire was distributed via SurveyMonkey between January 27 and March 26, 2026. Descriptive statistics were used.ResultsA total of 77 complete responses were analyzed (response rate 55.7%). Awareness of MISTs was high; however, 29.6% of respondents did not perform any MIST procedures. Compared with medical therapy, MISTs were generally perceived as more effective for improving lower urinary tract symptoms, particularly Rezūm (73.2%) and UroLift (52.7%). Conversely, MISTs were considered less effective than conventional surgery but superior in preserving sexual function and reducing side effects. The most frequently reported barriers to adoption included limited access to training, lack of mentorship, equipment availability, and cost constraints. Most respondents anticipated increased use of MISTs over the next three years. Limitations include the survey-based design, the predominance of academic respondents, and the limited procedural experience of some participants.ConclusionsDespite recognized functional advantages, the adoption of MISTs remains limited by concerns regarding efficacy and structural barriers. Improved training, access, and long-term evidence may facilitate broader implementation in clinical practice.

IntroductionFailty refers to a state of vulnerability to stressors caused by declines in physiological reserve across multiple systems and is associated with adverse health outcomes. Despite its established importance in medical specialties, frailty assessment remains inconsistently implemented in urology. The aim of this review was to provide an overview of the concept of frailty and summarise the current evidence regarding its relevance to urological practice.MethodsA narrative literature review was performed using PubMed/MEDLINE and Google Scholar. Articles relating to frailty, geriatric and perioperative care, surgical outcomes, and urology were identified and reviewed. Findings were synthesised to provide a clinical overview relevant to healthcare professionals working in urological settings.ResultsFrailty is common among older adults and is increasingly recognised as a marker of vulnerability beyond chronological age alone. Multiple validated assessment tools are available, including the Clinical Frailty Scale and Frailty Index, although no single instrument has demonstrated clear superiority. Existing evidence suggests that frailty is associated with higher rates of postoperative complications, mortality, prolonged hospitalisation, and increased healthcare utilisation in urological patients. Studies further indicate that comprehensive geriatric assessment may identify potentially modifiable risk factors and support frailty-informed care pathways. While most published data relate to elective uro-oncological surgery, emerging evidence from acute urology suggests that integration of geriatric services may improve outcomes such as length of stay and hospital readmission.ConclusionsFrailty is highly relevant to contemporary urological practice and appears to be a stronger predictor of adverse outcomes than chronological age alone. Routine frailty assessment using simple validated tools may enhance risk stratification, perioperative planning, and shared decision-making. Wider implementation of frailty-informed care pathways and greater incorporation of frailty measures into urological research should be prioritised as the population ages.

CONTEXT:To evaluate the safety and efficacy of ureteroscopy (URS) in adults receiving systemic anticoagulant (AC) therapy, including vitamin K antagonists and direct oral anticoagulants (DOACs), compared with non-AC controls. OBJECTIVE:Using a Population, Intervention, Comparator, Outcomes (PICO) framework, we examined whether continuation, interruption, or peri-operative bridging of AC influences bleeding complications, thromboembolic events, and stone-free rates (SFR) in adults undergoing URS for stone disease. EVIDENCE ACQUISITION:A systematic review of PubMed, Embase, and Scopus identified studies reporting URS outcomes in anticoagulated patients. The review adhered to PRISMA standards and was registered with PROspective Register of Systematic Reviews (PROSPERO) (Centre for Reviews and Dissemination (CRD)420251154766). Studies limited to antiplatelet monotherapy were excluded. Random-effects meta-analysis was performed for outcomes where sufficient comparative data were available. SFR was summarised descriptively. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I). EVIDENCE SYNTHESIS:Eleven studies (1,516 AC patients; 20,708 controls) published between 1998 and 2024 met inclusion criteria. Anticoagulation was not associated with a statistically significant increase in overall postoperative complications (RR 1.83, 95% CI 0.95-3.52). Bleeding-related complications were variably reported across studies, with absolute event rates ranging from 0-20% in anticoagulated patients and 0-0.60% in controls. In the largest comparative cohort, bleeding occurred in 1.1% (8/702) of anticoagulated patients versus 0.40% (44/10,859) of controls. Thirty-day readmission rates did not differ significantly (RR 1.59, 95% CI 0.27-9.29). SFRs ranged between 70-97% across studies. Most studies were judged at serious risk of bias, primarily due to non-random allocation of AC strategies. CONCLUSIONS:Bleeding complications were variably reported across studies, with several observational cohorts reporting higher absolute bleeding rates in anticoagulated patients than controls, although definitions were heterogeneous and absolute event rates were low. Thromboembolic events were rare. Continuation may be justified in carefully selected high-thrombotic-risk patients.

Purpose of review Environmental sustainability is increasingly relevant to urology, yet its structured integration into medical and specialty education remains limited. This review examines faculty and student perspectives on sustainability and evaluates current approaches to environmental sustainability in medical training. Recent findings Current evidence demonstrates high awareness and strong willingness among urologists and trainees to participate in sustainability initiatives; however, institutional metrics and formal educational frameworks are lacking. Most documented activities are brief, elective, and primarily knowledge based. Data from urologic practice reveal considerable variability in emissions associated with imaging, endoscopic technologies, and perioperative workflows, highlighting the necessity for specialty-specific educational strategies. Integrating sustainability into clinical decision-making and quality improvement processes appears more effective than isolated lectures. Nevertheless, there is limited evidence linking training interventions to behavioral change and measurable environmental outcomes. Summary Sustainability education in urology is evolving but fragmented. Faculty engagement, trainee involvement, and competency-based integration into operative workflows are essential for durable implementation within specialty training frameworks.

To evaluate the impact of position of the external end of the ureteral access sheath (UAS) on the regulation and management of intrarenal pressure (IRP) using 4 different scopes with varying working channel diameters. An ex-vivo study evaluating four single-use flexible ureteroscopes was performed. The IRP measurements were performed with the flexible ureteroscopes only and with 10/12Fr and 12/14Fr UASs together with flexible ureteroscopes. The main variable of interest was the position of the external end of the UAS termed as high (30 cm above), middle (15 cm above) and low (at the kidney level). The highest maximal IRPs were recorded with the 9.2Fr PU400A Pusen scope in all settings. Minor differences were noted between the measurements with no UAS and with UAS in high position. Decreasing the end position of the UAS from high to middle and low resulted in significant decline of IRPs, 33.3

Background Artificial intelligence (AI) is increasingly applied in endourology to enhance surgical planning, risk stratification, and outcome prediction. This systematic review evaluates AI-labelled prediction models predicting treatment-related outcomes in patients with urinary stone disease undergoing endourological procedures. Methods A systematic search of PubMed, EMBASE, Scopus, and Web of Science was conducted up to May 2025, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Original studies assessing AI-labelled prediction models for clinical outcomes after ureteroscopy, retrograde intrarenal surgery, or percutaneous nephrolithotomy were included. Data were extracted on modelling approach, outcomes, prevalence, and reporting of discrimination, calibration, and clinical utility, as well as the validation strategy. The protocol was registered in PROSPERO (CRD420251090820). Results Twenty-five studies were included, mostly retrospective and from Asian or European centres. Stone-free rate was the most frequent outcome. Infectious outcomes included febrile urinary tract infection, systemic inflammatory response syndrome, sepsis, fungal infection, and pyonephrosis, while other outcomes comprised operative time, radiation exposure, impacted stones, stone composition, transfusion, stenting, and broader perioperative outcomes. Across outcomes, discrimination was commonly reported, whereas calibration and formal assessment of clinical utility were less consistently reported; validation was predominantly internal, with limited external or temporal validation. One study reported a web-based implementation. Conclusions AI-labelled prediction models have been developed for multiple clinically relevant outcomes in urinary stone surgery. However, calibration, clinical utility, and robust validation remain inconsistently reported. Future work should prioritise transparent reporting of these elements, alongside multicentre external or temporal validation and more standardised outcome definitions, before routine clinical adoption.

Ureteral stents are essential in routine urologic practice for maintaining urinary drainage and preventing obstruction. Traditional stents are often associated with pain, urinary symptoms, encrustation, infection, and the need for secondary removal procedures. In theory, an “ideal” ureteral stent would address these challenges. This scoping review summarizes contemporary advancements in ureteral stent technology, including innovations in material and design, functional mechanisms, coating systems, and drug elution. An electronic literature search was performed on MEDLINE, EMBASE, Web of Science, and Cochrane Library using MeSH terms from inception to August 2025. Screening and data extraction were performed by two independent reviewers. All studies reporting on technological innovations and advancements in ureteral stent design aimed at improving clinical outcomes and reducing patient morbidity were included. Of the 1407 identified studies, 62 were included in the final review. The included studies were categorized into the following specific categories: stent material, design, and positioning, anti-reflux mechanisms, biodegradable stents, stent removal innovations, stent coatings and drug-eluting systems. Despite substantial advancements in stent technology, no universal “ideal” stent exists. Contemporary advancements in ureteral stent technology span across multiple domains, including innovations in stent material and design, anti-reflux mechanisms, biodegradable systems, stent coatings, and drug-eluting systems. Future ureteral stent development is anticipated to focus on patient-specific customization. Continued translational research and clinical validation are required to integrate many of these ureteral stent innovations into routine urological practice.

BACKGROUND:Radical prostatectomy (RP) is a widely used treatment for localized prostate cancer, where achieving negative surgical margins is essential to reduce the risk of biochemical recurrence (BCR) and avoid additional treatments like radiation therapy. Positive surgical margins (PSMs) are associated with increased recurrence rates, higher costs, and patient anxiety. This review aims to evaluate real-time technologies for surgical margin assessment during RP, focusing on their clinical utility, advancements, and potential to improve intraoperative decision-making. METHODS:A non systematic review was conducted by searching PubMed/MEDLINE and Google Scholar for studies on realtime intraoperative margin assessment technologies in RP, including traditional and emerging methods. The review assessed technologies such as frozen section analysis, Confocal Laser Endomicroscopy (CLE), Fluorescence Confocal Microscopy (FCM), Optical Spectroscopy, and Augmented Reality (AR). Data from clinical trials and studies were analyzed based on their sensitivity, specificity, operational feasibility, and potential to reduce PSMs. RESULTS:Emerging technologies like CLE and FCM have shown significant potential for intraoperative tissue imaging, offering high-resolution, real-time feedback that can help identify cancerous tissue and guide surgical margins. Frozen section analysis remains the gold standard for intraoperative assessment due to its high sensitivity and specificity, but it is time-consuming and dependent on specialized pathology teams. AR, CLE, and optical spectroscopy technologies are gaining attention for their ability to provide real-time data and improve surgical precision. However, challenges such as high costs, technical complexity, and limited availability in resource-limited settings hinder broader adoption. Further clinical validation is needed to confirm their effectiveness and feasibility. CONCLUSIONS:Real-time assessment technologies offer promising advancements in reducing PSMs during RP, potentially improving both oncological and functional outcomes. While frozen section analysis remains the most widely used method, emerging technologies like CLE, FCM, AR, and optical spectroscopy show promise in enhancing surgical precision and patient outcomes. Continued innovation and large-scale clinical trials are crucial for integrating these tools into standard clinical practice and making them more accessible to a broader patient population.

To evaluate how to assess the optimal length of flexible and navigable suction ureteral access sheaths (FANS) to be used during flexible ureteroscopy (FURS) for kidney stones. A prospective multicenter study (16 centers, July 2024–January 2025) enrolled 226 adults with normal renal anatomy undergoing FURS with FANS for renal stones. Three preoperative measurements were analyzed: (1) Subjective on X-ray: T12–pubic symphysis, (2) Objective on CT: upper pole–pubic symphysis, and (3) Dynamic ureteral catheter length with retrograde pyelogram (RPG): upper pole–urethral meatus. Sheath length appropriateness (too short/correct/too long) was assessed intraoperatively using predefined criteria (complete calyceal access, ergonomics, need for ancillary techniques). Secondary outcomes included 30-day stone-free rates (SFR) and complications. Sheath length was deemed correct in 63.7

Flexible ureteroscopy (F-URS) with suction technology has become a minimally invasive surgery for the management of renal stones. While the Flexible and Navigable Suction Ureteral Access Sheath (FANS) and Direct In-Scope Suction (DISS) ureteroscopes individually have proven benefits and restrictions, there is no dedicated research if integrating both these technologies can complement the limitations of each to improve suction F-URS outcomes. This audit introduces the Flexible Integrated Retrograde Suction-Ureteroscopy Technique (FIRST) procedure, which integrates FANS with a DISS ureteroscope, and compares its outcomes against DISS combined with a conventional ureteral access sheath (C-UAS). This prospective audit enrolled 64 adult patients undergoing F-URS with a DISS ureteroscope between August 2024 and October 2025 at 2 institutions. Patients were allocated to DISS with FANS (Group 1, n = 37) or DISS with C-UAS (Group 2, n = 27) based on surgeon discretion and device availability. The primary outcome was 30-day stone-free rate (SFR) assessed by non-contrast CT scan (single fragment up to 2 mm). Secondary outcomes included perioperative complications, renal function, and 3-month residual fragment rate, and the surgeon-reported ergonomics of procedures. Despite significantly greater stone burden in Group 1, the FIRST procedure achieved a superior 30-day SFR of 83.8

Elevated intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL) is linked to postoperative infectious morbidity. This systematic review and meta-analysis evaluated suction-assisted PCNL versus conventional PCNL regarding IRP and clinical outcomes. Registered in PROSPERO (CRD420251235580), this study followed PRISMA guidelines. Primary outcome was IRP; secondary outcomes included postoperative fever, sepsis, Clavien–Dindo ≥ 2 complications, operative time, hospital stay, and stone-free rate. Random-effects models and I2 statistics were used. Bias was assessed via Cochrane ROB-2 and ROBINS-I tools. Eight studies involving 1,171 patients (577 suction-assisted; 594 conventional) were included. Quantitative synthesis of six studies showed suction-assisted PCNL maintained significantly lower IRP (2.7–16.9 mmHg) compared to conventional groups (15.4 to > 30 mmHg), effectively preventing prolonged episodes of ≥ 30 mmHg. Suction-assisted PCNL was associated with significantly lower risks of postoperative fever and Clavien–Dindo ≥ 2 complications. Pooled analysis suggested reduced sepsis risk, though confidence intervals were wide due to low event rates. Suction cohorts reported no pressure-related severe infections. Additionally, suction-assisted PCNL demonstrated shorter operative times, shorter hospital stays, and higher stone-free rates. Heterogeneity was low to moderate across most outcomes. Suction-assisted PCNL provides superior IRP control and more favorable perioperative outcomes than conventional PCNL. While these systems appear to reduce infectious morbidity and complications, additional high-quality randomized controlled trials are required for confirmation.

This study aimed to evaluate the real-world trifecta efficacy of the Magneto laser technology used in endoscopic enucleation of the prostate (EEP), defined by three criteria: absence of Clavien-Dindo grade II, III, or IV complications within the first 30 days postoperatively; maximum urinary flow rate (Qmax) > 15 ml/sec within 3 months; and the absence of stress urinary incontinence beyond the 3-month follow-up period. This study included any patient fit for EEP for benign prostatic hyperplasia with the Magneto laser technology in five countries from March-September 2025. Exclusion criteria were concomitant surgery and patients < 18 years of age. Patients were divided into two cohorts for comparison according to prostate volume (< 80 cc and ≥ 80 cc). Baseline demographics, operative characteristics and postoperative outcomes were compared and reported as per trifecta definition. 184 patients were analyzed; 85 had prostate volume < 80 cc and 99 had prostate volume ≥ 80 cc. Median age was 70 years, median preoperative IPSS was 27, median preoperative maximum flow rate was 7.3 ml/s, 50

With the increasing adoption of single-use ureteroscopes in retrograde intrarenal surgery (RIRS), concerns regarding cost and environmental sustainability have prompted interest in their reuse, giving rise to the concept of reused disposable scopes (RDS). This study evaluates the impact of RDS on perioperative outcomes in RIRS when used in conjunction with novel technologies such as the flexible and navigable suction access sheath (FANS). This prospective multicenter study included 607 adult patients undergoing RIRS with RDS across 12 international centers between July 2025 and March 2026. The primary outcomes were stone-free rate (SFR) and perioperative complications. Subgroup analyses were performed based on the number of prior uses and cumulative duration of prior ureteroscope use. The median operative time was 60 min, and intraoperative scope failure occurred in 15.0

To evaluate the real-time safety profile and intrarenal pressure (IRP) dynamics of two suction-assisted ureteroscopic systems, the Direct In-Scope Suction (DISS) and Flexible and Navigable Suction (FANS) ureteral access sheath, in an ex-vivo model. Four porcine kidney-ureter units were used, harvested from two female pigs (32–34 kg). A 20G intravenous catheter was inserted into the middle calyx for continuous IRP monitoring via a pressure transducer and monitor. Each kidney underwent four experimental configurations combining 7.5 Fr PU3033AH or 9.2 Fr PU400A DISS scopes with 9.5/11.5 Fr or 12/14 Fr FANS sheaths. Irrigation was performed using a manual hand pump, and suction was applied at 100 mmHg either through the ureteroscope or sheath. Measurements included baseline and maximal IRPs, suction-induced changes, mucosal injury, and time to endoscopic stone-free status (ESFS). Sixteen experiments were completed. Activation of suction consistently reduced IRP across all settings. The The 7.5 Fr DISS + 9.5/11.5 Fr FANS configuration achieved the lowest pressures (4–12 mmHg) but caused pelvicalyceal collapse and six mucosal injuries. In contrast, the 9.2 Fr DISS + 12/14 Fr FANS combination-maintained IRP between 12 and 28 mmHg with efficient fragment evacuation and minimal collapse. Both DISS and FANS effectively maintained IRP within a safe range. Controlled, balanced suction was crucial for safety, while excessive negative pressure or prolonged manual irrigation risked collapse and mucosal injury. The 9.2 Fr DISS + 12/14 Fr FANS configuration demonstrated stable pressure control and efficient performance in this experimental model.