RIRS for an Impacted Large Ureter Stone, Case of the Month [Dec. 2016]

A 71-year-old female patient with an impacted large ureter stone (16x11x10mm) and another renal stone in lower-pole posterior calyx (10x10x10 mm)

What is your option? Laparoscopy with an assistance of a flexible cystoscope? RIRS? AIRS? (antegrade flexible ureteroscopy)

I chose RIRS. Only a single terumo G/W could be inserted through the stone in the ureter, and the terumo G/W could not reach the renal pelvis because of the ureteral kinking.

Then what is your next plan? 'Over the G/W technique (sliding technique)' was possible because of the narrow ureterovesical junction. I chose the Lithovue disposable flexible ureterorenoscope with a very short 11/13Fr-sized ureteral access sheath.

We are in!! This approach was successful with little damage to the reusable scope and the ureter, and comfortable for the surgeon as well. Although the operation was extremely long (120 minutes), I think RIRS was the better option than laparoscopy. Antegrade approach would be also feasible.