Abstract
Introduction: The aim of the study was to evaluate the efficacy and safety of percutaneous antegrade flexible ureteroscopic lithotripsy (PAFUL) using a tip-bendable suction ureteral access sheath (UAS) for managing middle and lower ureteral stones after failed retrograde ureteroscopy. Methods: This retrospective study analyzed 75 patients (43 males, 32 females; mean age 51.7 ± 13.1 years) with middle (n = 54) and lower (n = 21) ureteral stones treated between June 2023 and May 2025. All patients underwent PAFUL with 12/14 Fr tip-bendable suction UAS after failed ureteroscopy. Outcomes included stone-free rate (SFR), operative time, complications, and hydronephrosis improvement. Results: The immediate and 1-month SFR was 100% (75/75). The mean operative time was 168.2 ± 35.9 min, with a median postoperative hospital stay of 3 days. Four patients (5.3%) required nephrostomy tube placement. Complications (Clavien-Dindo grade I) included fever (n = 2), nausea/vomiting (n = 8), and pain (n = 18). No grade II–V complications occurred. Postoperative hydronephrosis significantly improved (p < 0.001), with complete resolution in 68 patients (90.7%). Conclusion: PAFUL with tip-bendable suction UAS is a safe and immediately effective alternative for mid-distal ureteral stones after failed retrograde treatment, achieving single-session clearance with minimal morbidity. Future studies should validate cost-effectiveness through reduced re-interventions and resource utilization.
