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Objective <p>To compare the efficacy and safety of flexible negative-pressure ureteral access sheath combined with flexible ureteroscopic lithotripsy (FURL) versus FURL alone in the treatment of upper urinary tract infectious stones.</p> Methods <p>This retrospective cohort study included 91 patients with upper urinary tract infectious stones (confirmed as struvite or carbonate apatite by postoperative stone composition analysis) who underwent surgery at the First Affiliated Hospital of Xiamen University between January 2023 and January 2025. Based on the surgical approach, patients were divided into two groups: the FANS-UAS combined with FURL group (<i>n</i> = 60) and the FURL alone group (<i>n</i> = 31). Baseline characteristics, stone-free rates (immediate and long-term), and complications were collected and compared between the groups.</p> Results <p>Compared to the FURL alone group, the FANS-UAS group had a lower proportion of struvite stones (73.33% vs. 93.55%, <i>P</i> &lt; 0.05) and a lower rate of intraoperative stone basket usage (66.67% vs. 100%, <i>P</i> &lt; 0.05). However, patients in the FANS-UAS group were older, had a larger maximum stone diameter, and higher stone CT values (all <i>P</i> &lt; 0.05). Regarding efficacy and safety: The FANS-UAS group demonstrated a significantly higher immediate stone-free rate (53.34% vs. 12.91%, <i>P</i> &lt; 0.05), but also had a longer operative time, greater estimated intraoperative blood loss, and higher postoperative levels of serum creatinine and cystatin C (all <i>P</i> &lt; 0.05). Concurrently, the FANS-UAS group showed significantly lower rates of systemic inflammatory response syndrome (1.67% vs. 6.45%, <i>P</i> &lt; 0.05), lower hospitalization costs, and a lower rate of postoperative adjuvant therapy (3.33% vs. 45.17%, <i>P</i> &lt; 0.05). However, no statistically significant differences were observed between the two groups in terms of long-term stone-free rate, postoperative pain scores, length of hospital stay, transfusion rate, fever rate, renal pelvis/ureteral injury rate, or reoperation rate (all <i>P</i> &gt; 0.05). Although these differences did not reach statistical significance, the observed numerical trends in some outcomes may hold clinical relevance and warrant further validation through larger-scale studies.</p> Conclusion <p>The combination of FANS-UAS and FURL is a safe and effective&#xa0;method for treating upper urinary tract infectious stones. Its advantages include a higher immediate stone-free rate, lower hospitalization costs, reduced need for postoperative adjuvant therapy, a lower incidence of sepsis, and faster postoperative recovery, while achieving a long-term stone-free rate comparable to FURL alone. This approach represents a viable new treatment option.</p>

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Efficacy and safety of flexible and navigable suction ureteral access sheath combined with flexible ureteroscopic lithotripsy versus flexible ureteroscopic lithotripsy alone for infected upper urinary tract stones: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年2月14日

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  • Qianhao Huang,
  • Meixuan Ding,
  • Xin Lian,
  • Yifan Huang,
  • Tao Wang,
  • Bin Chen,
  • Yuedong Chen

摘要

Objective

To compare the efficacy and safety of flexible negative-pressure ureteral access sheath combined with flexible ureteroscopic lithotripsy (FURL) versus FURL alone in the treatment of upper urinary tract infectious stones.

Methods

This retrospective cohort study included 91 patients with upper urinary tract infectious stones (confirmed as struvite or carbonate apatite by postoperative stone composition analysis) who underwent surgery at the First Affiliated Hospital of Xiamen University between January 2023 and January 2025. Based on the surgical approach, patients were divided into two groups: the FANS-UAS combined with FURL group (n = 60) and the FURL alone group (n = 31). Baseline characteristics, stone-free rates (immediate and long-term), and complications were collected and compared between the groups.

Results

Compared to the FURL alone group, the FANS-UAS group had a lower proportion of struvite stones (73.33% vs. 93.55%, P < 0.05) and a lower rate of intraoperative stone basket usage (66.67% vs. 100%, P < 0.05). However, patients in the FANS-UAS group were older, had a larger maximum stone diameter, and higher stone CT values (all P < 0.05). Regarding efficacy and safety: The FANS-UAS group demonstrated a significantly higher immediate stone-free rate (53.34% vs. 12.91%, P < 0.05), but also had a longer operative time, greater estimated intraoperative blood loss, and higher postoperative levels of serum creatinine and cystatin C (all P < 0.05). Concurrently, the FANS-UAS group showed significantly lower rates of systemic inflammatory response syndrome (1.67% vs. 6.45%, P < 0.05), lower hospitalization costs, and a lower rate of postoperative adjuvant therapy (3.33% vs. 45.17%, P < 0.05). However, no statistically significant differences were observed between the two groups in terms of long-term stone-free rate, postoperative pain scores, length of hospital stay, transfusion rate, fever rate, renal pelvis/ureteral injury rate, or reoperation rate (all P > 0.05). Although these differences did not reach statistical significance, the observed numerical trends in some outcomes may hold clinical relevance and warrant further validation through larger-scale studies.

Conclusion

The combination of FANS-UAS and FURL is a safe and effective method for treating upper urinary tract infectious stones. Its advantages include a higher immediate stone-free rate, lower hospitalization costs, reduced need for postoperative adjuvant therapy, a lower incidence of sepsis, and faster postoperative recovery, while achieving a long-term stone-free rate comparable to FURL alone. This approach represents a viable new treatment option.