Does the Ureteral Access Sheath Reduce Infections in Previously Drained Sepsis Patients? UAS and Infection Rates Post Sepsis-Drainage

Purpose Flexible ureteroscopy is the main treatment in upper tract urolithiasis. In cases of urinary tract infection associated to ureterolithiasis, drainage is required. Different authors prefer using a ureteral access sheath (UAS) to reduce complications. Our objective is to analyze the role of UAS in patients undergoing flexible ureteroscopy previously drained endoscopically for urosepsis. Methods Retrospective single-center study. We reviewed patients with urolithiasis associated with urosepsis requiring endoscopic drainage between 2017-2024. Only patients undergoing flexible ureteroscopy as final treatment were selected. We compared those using a UAS versus those who did not. Statistical analysis used Chi-square and Mann-Whitney tests. Results 77 patients met the inclusion criteria. The average age was 59 years, and the average stone size was 8.8 mm. UAS was used in 59.7% of patients. There were no differences in age, gender, stone size, stone location, comorbidities, and fever incidence on ER admission. We only report differences in previous ipsilateral ureteroscopy, with a higher incidence in the UAS group. In the UAS group, there were 13% complications at 3 months (Clavien Dindo>II), all infectious. In patients without UAS, a 12.9% complication rate was recorded. Only 1 patients had an infectious complication (non-febrile), and the rest were associated with pain due to residual stone. Regarding the percentage of SFR, there was no difference and there was no difference in the use of postoperative JJ-stent. Conclusions In our series, UAS doesn’t show a benefit in the rate of post-operative infections, though it could have a role in post-operative mechanical complications.