1 RIRS and 3 MPCNLs

1. RIRS for RKLP stone; 2. Lt staghorn stone + RKLP small stone; 3. LK complete staghorn stone; 4. RK staghorn stone in a horseshoe kidney.

RIRS for RKLP stone: Fortunately, no impacted stones. I used FLEX-X2, 11/13Fr access sheath and 200/365 mm laser fiber and zero tip nitinol stone basket. Op time: 50 min.

Left staghorn stone + RKLP small stone; Right RIRS first and then, Left MPCNL (15Fr scope and 18Fr balloon). No flexible scope was inserted for ECIRS. Op. time: 55 min.

LK complete staghorn stone: Left MPCNL (18Fr) and flexible scope was inserted to catch some fragmented stones in the upper pole calyx. Op. time: 60 min.

RK staghorn stone in a horseshoe kidney: upper pole approach. Right MPCNL (18Fr) without a flexible scope. Hydronephrotic kidney and very hard multiple stones. Op. time: 50 min.