Challenging convention: primary ureteroscopy for stone disease with concomitant infection—a multicentre study

Obstructing urolithiasis with concomitant infection presents a major clinical challenge. While urgent decompression is standard, the safety of early definitive stone treatment remains uncertain. This study evaluates the outcomes of primary ureteroscopy compared with delayed intervention following decompression. To investigate whether early ureteroscopy is a safe treatment option for the management of urolithiasis in the context of concomitant urinary infection. A multi-institutional observational study (2019–2023) included adults with radiologically confirmed obstructing urolithiasis and infection. Patients underwent either primary ureteroscopy within 24 h without prior decompression (Group A) or decompression with deferred ureteroscopy during the same admission (Group B). Primary outcomes were postoperative complications and stone-free rate (SFR). Secondary outcome was hospital length of stay (LOS). Statistics were performed using odds ratios (OR) or mean difference and comparative parameters. Forty-four patients were included: 29 in Group A and 15 in Group B. Group A patients had lower ASA scores and smaller mean stone size (7.2 mm vs 11.2 mm, p = 0.003). The overall SFR was 79.6%, significantly higher in Group A than Group B (89.7% vs 60%, OR 5.78, p = 0.029). Median LOS was shorter in Group A (3 vs 8 days, p = 0.038). Postoperative complication rates were low and comparable. Prolonged infection occurred in 6% of Group A and 13% of Group B (p = 0.48). Primary ureteroscopy may be a safe and effective strategy in selected patients with obstructing urolithiasis and concomitant infection, offering reduced hospitalisation without increased complications. Larger prospective studies are required to validate these findings.