Intelligent pressure-guided flexible ureteroscopic lithotripsy improves stone-free rates and reduces infectious complications in upper urinary tract infectious stones.

BACKGROUND: Standard flexible ureteroscopy lithotripsy (FURL) for upper urinary tract infectious stones carries risks of high intrarenal pressure (IPP) and postoperative infection. We evaluated whether an intelligent pressure-guided system improves outcomes. METHODS: This retrospective study included 269 patients with upper urinary tract infectious stones that were received by the First Hospital of Hebei Medical University from May 2022 to December 2025. Patients were divided into the Standard Group (n = 142, standard FURL) and the Intelligent Group (n = 127, intelligent pressure-guided FURL). Primary outcomes were stone-free rate (SFR) at postoperative day 1, 1, and 3 months, during key procedural stages, and complications. Secondary outcomes included operative time, hospital stay, renal function, and inflammatory markers. RESULTS: The Intelligent Group achieved significantly higher SFRs at day 1 (87.40% vs. 73.24%, P = 0.004) and month 1 (93.70% vs. 81.69%, P = 0.003). Operative time (52.62 vs. 66.35 minutes, P < 0.001) and hospital stay (3.94 vs. 5.27 days, P < 0.001) were shorter. Mean IPP during lithotripsy was lower in the Intelligent Group. Postoperative elevations in renal function and inflammatory markers were attenuated (all P < 0.05). Postoperative fever was lower (4.72% vs. 16.90%, P = 0.002). CONCLUSIONS: Intelligent pressure-guided FURL improves stone clearance, shortens convalescence, and reduces infectious complications compared to standard FURL for upper urinary tract infectious stones.