Efficacy of Percutaneous Antegrade Flexible Ureteroscopic Lithotripsy with Tip-Bendable Suction Ureteral Access Sheath for Middle and Lower Ureteral Stones.

Introduction: 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 one-month SFR was 100% (75/75). The mean operative time was 168.2±35.9 minutes, 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.