Breaking the stone and beating the bug: managing ureterolithiasis with Enterococcus faecium in a high-risk patient

Ureteral lithiasis in high-risk patients demands a personalized approach due to the interplay of multiple comorbidities and procedural risks. This case report examines a 66-year-old female with recurrent lower ureteral stones resistant to multiple extracorporeal shock wave lithotripsy sessions, complicated by multidrug-resistant <i>Enterococcus faecium</i> infections, chronic coronary syndrome, heart failure with preserved ejection fraction, diabetes mellitus, and a history of ischemic stroke. The failure of conservative treatments required a shift to ureteroscopic laser lithotripsy, preceded by cardiovascular risk optimization and targeted antimicrobial therapy based on advanced microbial diagnostics. Postoperative imaging confirmed complete stone clearance and correct stent placement, ensuring ureteral patency. This case underscores the necessity of multidisciplinary management, integrating precise infection control, cardiovascular stabilization, and minimally invasive techniques to achieve a favorable outcome in a complex patient.