What is your option?
(2) PCN and antegrade approach with f-URS
You can encounter difficult situations when you choose RIRS
(1) difficult approach to renal pelvis
(2) passive deflection to upper pole and can't reach to the stones
(3) difficult pop-dusting when approach is not freely movable with mucosal injury
Principles for RIRS in patients with stones in the transplanted kidney by Cho SY
(1) Preoperative bladder exam (cystoscopy): Check the urine volume
(2) Keep the same bladder volume and find the ureteral anastomotic location
(3) Negotiation of submucosal tunnel of the anastomotic ureter
(4) Consider pre-stenting for > 1 week
(5) Try to place a short UAS < 30 cm)
(6) Consider use of a disposable flexible ureterorenoscope because of the distorted ureter
(7) Stones should be migrated into a single calyx to avoid excessive twisting of the f-URS
(8) Place the DJ catheter < 30 cm.