Vacuum-assisted dedusting lithotripsy: a retrospective comparative study in high-risk patients with positive preoperative urine cultures

ObjectiveThis study aimed to compare the efficacy of vacuum-assisted dedusting lithotripsy (VADL), employing a flexible vacuum-assisted ureteral access sheath (FV-UAS), with traditional flexible ureteroscopic lithotripsy (fURL) for upper urinary tract stones in patients with positive urine cultures.MethodsA retrospective analysis was conducted on 421 patients treated with fURL between January 2022 and August 2024. Patients were divided into a traditional fURL group and a VADL group. Propensity score matching adjusted for baseline differences, with a 1:1 ratio applied to compare stone-free rates, operative durations, postoperative hospital stay durations, and postoperative infectious complications.ResultsAmong 114 well-matched patients in each group, no mortalities occurred. The VADL group demonstrated significantly lower incidences of postoperative systemic inflammatory response syndrome (SIRS) (7.0% vs. 15.8%, p = 0.037) and shorter hospital stays (2.0 [1.0, 2.0] vs. 1.0 [1.0, 2.0], p = 0.014). The stone-free rate was significantly higher in the VADL group (87.7% vs. 72.8%, p = 0.005). However, no significant differences were observed in postoperative fever incidence or operative duration (7.0% vs. 9.6%, p = 0.472; 55.5 [40.0, 75.0] vs. 60.0 [45.0, 75.0], p = 0.104).ConclusionsVADL significantly reduces postoperative infectious complications and enhances stone-free rates in patients with upper urinary tract stones and positive preoperative urine cultures undergoing ureteroscopic lithotripsy.