Enhanced Pressure Management Using an Upgraded Vacuum-Assisted Ureteroscopic System: Experimental Validation and Predictive Modeling

Introduction: The aim of this study was to evaluate the pressure-control performance and irrigation efficiency of an upgraded vacuum-assisted ureteroscopic system (VA-URS) compared with traditional ureteroscopy (T-URS) using an in vitro kidney model. Methods: An artificial renal pelvis model was used to simulate ureteroscopy under varying irrigation pressures (50, 100, 150 cmH2O) and flow rates (30–50 mL/min). Intrapelvic pressure and effective irrigation flow rates were continuously recorded. Three-way ANOVA assessed the influence of surgical method, irrigation pressure, and flow rate, while multiple regression models quantified pressure-parameter relationships. Results: VA-URS consistently produced lower intrapelvic pressures than T-URS across all settings. At 50 cmH2O with 30 mL/min, pressures were −21.47 ± 1.86 cmH2O versus 24.73 ± 1.56 cmH2O (p < 0.01). At 150 cmH2O with 50 mL/min, values were 50.13 ± 2.14 cmH2O versus 61.53 ± 1.27 cmH2O (p < 0.01). Effective irrigation flow was also higher with VA-URS (24.50 ± 0.79 vs. 20.40 ± 0.70 mL/min at 50 cmH2O/30 mL/min; p < 0.01). Regression modeling demonstrated strong predictive accuracy (R2 = 0.984 for VA-URS) and distinct pressure-flow dynamics compared with T-URS. Conclusions: The upgraded VA-URS system significantly enhances intrapelvic pressure management and irrigation efficiency compared with T-URS in this in vitro model. These bench findings support further translational evaluation; however, animal and clinical studies are required to confirm clinical benefit and safety.