Clinical Scorecard: Comparative Analysis of the Effectiveness and Safety of a Flexible Navigable Suction Ureteral Access Sheath with Flexible Ureteroscopic Lithotripsy Versus Flexible Ureteroscopic Lithotripsy Alone for Treating Infected Upper Urinary Tract Stones: A Retrospective Cohort Investigation

At a Glance

Key Highlights

• Infected stones constitute approximately 15% of urinary tract stones and are characterized by rapid growth and high complication risk.
• Flexible ureteroscopic lithotripsy (FURL) combined with flexible navigable suction ureteral access sheath (FANS-UAS) enhances stone clearance by reducing intrarenal pressure and facilitating removal of powdered stone fragments.
• Retrospective cohort study comparing FURL alone versus FURL combined with FANS-UAS showed potential improvements in efficacy and safety for infected upper urinary tract stones.

Guideline-Based Recommendations

Diagnosis

• Preoperative CT imaging for precise stone localization and characterization.
• Stone composition analysis confirming struvite or carbonate apatite to identify infected stones.
• Urine culture and urinalysis to guide antibiotic therapy.

Management

• Complete stone eradication combined with antibiotic therapy is essential.
• Preoperative infection control with antibiotics based on culture sensitivity or empirical therapy if indicated.
• Flexible ureteroscopic lithotripsy (FURL) with or without FANS-UAS as surgical options, with FANS-UAS facilitating improved stone fragment removal.
• Prophylactic antibiotics administered one hour before surgery.

Monitoring & Follow-up

• Preoperative laboratory tests including leukocytes, hemoglobin, urine culture, liver and kidney function, and coagulation profiles.
• Postoperative monitoring for infection control and complications.

Risks

• Potential for systemic inflammatory response syndrome (SIRS) and sepsis if bacteria enter circulation.
• Surgical risks associated with stone removal procedures.
• Need for careful patient selection excluding those with severe comorbidities or active systemic infection.

Patient & Prescribing Data

Patients with infected upper urinary tract stones undergoing surgical treatment with FURL or FURL combined with FANS-UAS.

Antibiotic therapy tailored to urine culture results is critical; prophylactic antibiotics reduce perioperative infection risk; FANS-UAS may improve stone clearance and reduce intrarenal pressure during lithotripsy.

Clinical Best Practices

• Ensure thorough preoperative evaluation including imaging and laboratory testing to confirm stone infection and patient suitability.
• Administer targeted antibiotic therapy preoperatively until infection is controlled before surgery.
• Use FURL combined with FANS-UAS to enhance stone fragment removal and reduce intrarenal pressure during surgery.
• Follow strict perioperative anti-infective protocols aligned with national guidelines.
• Exclude patients with severe comorbidities or active systemic infections to minimize surgical risks.

References

• Chinese Guidelines for the Diagnosis and Treatment of Urological and Male Diseases
• STROBE Reporting Guideline