Does the ureteral access sheath reduce infections in previously drained sepsis patients?

PURPOSE: Flexible ureteroscopy is the main treatment option 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 and 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: Seventy-seven patients were included, with UAS used in 59.7%. Baseline characteristics were comparable between groups. Infectious complications occurred in 13% of UAS patients vs. 3.2% of non-UAS patients (p = 0.17). Overall SFR was 84% with no significant difference between groups. Across all multivariable models, stent dwell time was the only independent predictor of postoperative infectious complications. UAS use was not independently associated with reduced or increased infection risk. CONCLUSIONS: In patients with prior drainage for urosepsis, ureteral access sheath use conferred no clear clinical benefit. Larger prospective studies are required to confirm these findings.