The reason why we should consider combined approach to the renal stones
This patient had a failure history of flexible ureteroscopy for his right-sided 1.8cm-sized renal stone in another hospital and he was referred to my hospital for 2nd opinion.
The stone was located in the lower pole of the right kidney in the CT images.
I had to consider abnormalities in the ureter and caliceal anatomy and the position should be modified supine position. Flexible ureteroscopy was the first option and percutaneous puncture was ready when necessary.
When I did flexible ureteroscopic approach, as you see the fluoroscopic view, there was calical infundibular stenosis with diverticular space. Another problem was ureteral narrowing not to allow insertion of safety GW or ureteral access sheath.
In this situation, percutaneous puncture is the only option.
We have to prepare modified supine position if the case is complicated.