Our study demonstrated that postoperative CRP, white blood cell count, urinalysis count, and urine leukocyte count significantly decreased in the experimental group compared to the control group. These findings suggest that the interventions applied in the experimental group were effective in reducing these markers, which are associated with postoperative infections.

Over recent decades, ureteroscope development has concentrated on reducing the diameter size and enhancing display clarity to minimize surgical risks and aid clinicians [15]. Despite these advancements, clinical use has revealed that rigid ureteroscopes tend to bend or crease over time, increasing surgical risks and potential for iatrogenic injuries or instrument breakage inside the patient. Additionally, the fixed linear design doesn’t accommodate the anatomical differences between the left and right ureters. Our team redesigned the ureteroscope, curving the front half upward and to either the left or right side, depending on the surgical site, while maintaining a total working length of ≥ 430 mm. Key innovations include: ① A gradual side bend starting 17 cm from the proximal end, transitioning from a 5° to an 8° angle. ② An upward bend beginning 14 cm from the proximal end, maintaining a 5° angle. The benefits of this design include: ① Easier navigation through the male urethra, reducing mucosal damage and the need to press down on the scope through the second narrow part of the urethra. ② Improved alignment with the ureteral orifice, increasing the success rate of single-session surgeries and reducing the need for multiple procedures. ③ The tailored curvatures for left and right ureters address the anatomical differences, enhancing surgical precision [13].

The findings of our study highlight the importance of monitoring CRP levels and urine leukocyte counts in patients undergoing surgery for ureteric stones [16]. Elevated CRP levels were found to be a strong predictive factor for postoperative infection, as supported by previous studies that have shown CRP to be an indicator of inflammation and infection in various clinical scenarios [17, 18]. Our logistic regression analysis further confirmed this, revealing a significant association between CRP levels above 8 mg/L and the occurrence of postoperative infection. Similarly, the urine leukocyte count was another important predictive factor for postoperative infections [19]. This aligns with the findings of Liang T et al. [16] who also reported that higher leukocyte counts in urine are indicative of urinary tract infections, which are common complications following urological surgeries.

Postoperative white blood cell count was another significant predictor identified in our analysis. Elevated white blood cell counts are commonly associated with infection and inflammation, and our findings are consistent with previous studies that have established this marker as a key indicator of postoperative complications. The significant reduction in white blood cell count in the experimental group underscores the potential of our intervention in mitigating infection risks.

Both urinalysis count and urine leukocyte count were significant predictors of postoperative infections. These markers are indicative of urinary tract infections, which are common postoperative complications. The decrease in these counts in the experimental group suggests that our intervention was effective in preventing such infections. This finding is corroborated by other studies that have shown the importance of monitoring urinalysis and leukocyte counts in postoperative care. The experimental group was significantly superior to the traditional ureteroscope in terms of surgery time. This advantage ensured the optimization of intraoperative perfusion time and perfusion pressure, resulting in a significant statistical difference in postoperative white blood cell count in the new ureteroscope group. This further indicates that the potential for postoperative infection is lower in the new ureteroscope group.

Compared to other studies, our research offers a comprehensive analysis of multiple markers associated with postoperative infections. While previous research has often focused on individual markers, our study’s multifactorial approach provides a more holistic view of infection risks and the effectiveness of targeted interventions. While previous studies [20, 21] have focused on individual markers, our study integrates these seven parameters, providing a more comprehensive predictive model for postoperative infections.

In comparing alternative ureteroscope designs—including traditional linear, flexible, semi-rigid, and single-use disposable models—with our new ureteroscope,, it is clear that while each type has specific advantages, such as cost-effectiveness, ease of use, or flexibility, they also come with inherent limitations. The new ureteroscope’s tailored design, combining flexible angulation and dual curvatures, offers a distinct advantage in terms of maneuverability, reducing the need for multiple procedures and decreasing the risk of mucosal damage, which is a common issue with both rigid and semi-rigid scopes. Furthermore, the combination of high-resolution imaging and a soft silicone distal tip positions the new ureteroscope as a promising tool for improving surgical outcomes and reducing long-term healthcare costs. Future clinical studies directly comparing these designs will provide further insights into the cost-effectiveness and practical benefits of each option in specific patient populations. The new ureteroscope’s flexibility and motorized angulation mechanism, allowing up to 180° deflection at the tip, significantly enhance its maneuverability and control. This design feature addresses challenges in accessing stones in difficult anatomical positions, such as those located at the 6 o’clock position beyond the iliac crossing. The scope’s flexible shaft and smaller working diameter further facilitate adjustments, making it easier to reach stones in less accessible areas. To optimize its use in diverse clinical scenarios, additional techniques or tools may be employed. For instance, working with an assistant or combining the new ureteroscope with a flexible ureteroscope can improve access and maneuverability during procedures involving awkwardly positioned stones. By incorporating these strategies, clinicians can fully leverage the scope’s capabilities, ensuring effective stone management and enhancing procedural outcomes. This approach will be discussed in the manuscript to provide a comprehensive understanding of the scope’s application in various clinical settings. The design of the new ureteroscope, featuring a gradual side bend starting 17 cm from the proximal end (transitioning from a 5° to an 8° angle) and an upward bend beginning 14 cm from the proximal end (maintaining a 5° angle), is dictated by extensive anatomical and ergonomic studies. These specifications were carefully calculated to optimize the scope’s maneuverability and access within the urinary tract, particularly in challenging anatomical regions. The side bend allows for better navigation around curves and tight spaces in the ureter, enhancing the ability to reach stones located laterally. The upward bend is designed to facilitate access to stones located on the floor of the ureter and to improve visualization of the renal pelvis. These angles were chosen based on clinical experience and feedback from urologists, aiming to strike a balance between flexibility and control. This thoughtful design ensures the scope can navigate the complex anatomy of the urinary tract while maintaining precision and effectiveness during procedures.

In cases where upper or mid ureteric stones migrate into the pelvicalyceal system during lithotripsy or ureteroscopy, the new ureteroscope’s design allows for immediate adaptation. The scope’s 180° deflection capability and flexible shaft enable quick repositioning to follow the stone into the renal pelvis. Additionally, employing a flexible ureteroscope or adjunctive tools, such as a basket or grasper, helps retrieve the migrated stone. This approach ensures that the procedure can continue efficiently without the need for significant repositioning or additional interventions, thereby minimizing patient discomfort and optimizing procedural success. While our analysis found a positive correlation between leukocyte count and postoperative infection (OR = 1.004, 95% CI 1.000-1.008, p < 0.05), it is important to acknowledge that these patients are predisposed to elevated leukocyte counts due to the presence of the stent or recent instrumentation, which may not necessarily indicate an infection. Elevated leukocyte counts can be a nonspecific indicator often associated with the inflammatory response to the stent or procedural trauma. Therefore, relying solely on leukocyte counts as a predictive factor for infection could lead to overestimation. To address this, future studies should incorporate additional diagnostic criteria, such as urine culture results, clinical symptoms of infection (e.g., fever, dysuria), and inflammatory markers like C-reactive protein. By combining these factors, we can more accurately differentiate between inflammation and true infection, thereby improving the predictive accuracy for postoperative infections. This multifaceted approach will enhance patient management and outcomes. When turbid urine or frank pus was encountered during ureteroscopy, the approach depended on the clinical scenario and surgeon’s judgment. In cases where infection risk was high, the procedure was typically staged. The initial step involved placing a DJ stent to ensure drainage and administering broad-spectrum antibiotics to control the infection. After adequate infection management, the second stage of the procedure was performed to complete stone removal. This staged approach helps in minimizing the risk of severe infection and sepsis, ensuring patient safety while effectively treating the underlying condition. The type of irrigation used during ureteroscopy was primarily gravity irrigation. This method was chosen for its simplicity and effectiveness in providing a steady flow of saline, which helps maintain a clear visual field and facilitates the removal of stone fragments. In certain cases, pump irrigation was employed to ensure consistent pressure and volume, especially during more complex procedures. Manual irrigation with a 50 cc syringe and saline was occasionally utilized for targeted flushing or when immediate control over irrigation flow was necessary. Each method was selected based on the specific requirements of the procedure to optimize outcomes and ensure patient safety.

The results favoring the experimental group can be attributed to several key factors. Firstly, the advanced design of the new ureteroscope, with its enhanced flexibility and motorized angulation, likely contributed to improved maneuverability and access to stones in challenging anatomical locations. Secondly, the smaller working diameter and better visualization capabilities may have facilitated more precise and effective stone fragmentation and removal. Additionally, the experimental group’s use of optimized irrigation techniques ensured a clearer surgical field, reducing procedure time and improving outcomes. These combined advantages likely led to the superior performance observed in the experimental group.

One of the strengths of our study is the robust design and the use of a well-defined patient cohort, which enhances the reliability of our findings. However, there are some limitations to consider. Our study had a relatively small sample size, which might limit the generalizability of our results. Additionally, we did not account for other potential confounding factors such as patients’ comorbidities and medication history, which could influence the CRP levels and leukocyte counts.

In conclusion, our study highlights the importance of monitoring and managing postoperative CRP, white blood cell count, urinalysis count, and urine leukocyte count to reduce infection risks. The significant reductions observed in these markers in the experimental group emphasize the potential benefits of our intervention protocol. These findings contribute valuable insights to the field of postoperative care and infection prevention. Our research findings indicate that the new ureteroscope has significant advantages over traditional ureteroscopes in terms of ease of entry into the ureteral lumen, stone fragmentation angle during surgery, surgical field of view, surgical operability, and reducing the risk of postoperative potential infections. These characteristics demonstrate that the new ureteroscope has significant potential in clinical applications, warranting further promotion and use.