Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Concomitant treatment of ureteral calculi and ipsilateral pelvic sciatic nerve schwannoma with transperitoneal laparoscopic approach: A case report

BACKGROUND Schwannomas are rare peripheral neural myelin sheath tumors that originate from Schwann cells.Of the different types of schwannomas,pelvic sciatic nerve schwannoma is extremely rare.Definite preoperative diagnosis of pelvic schwannomas is difficult,and surgical resection is the gold standard for its definite diagnosis and treatment.CASE SUMMARY We present a case of pelvic schwannoma arising from the sciatic nerve that was detected in a 40-year-old man who underwent computed tomography for intermittent right lower back pain caused exclusively by a right ureteral calculus.Subsequently,successful transperitoneal laparoscopic surgery was performed for the intact removal of the stone and en bloc resection of the schwannoma.The total operative time was 125 min,and the estimated blood loss was inconspicuous.The surgical procedure was uneventful.The patient was discharged on postoperative day 5 with the simultaneous removal of the urinary catheter.However,the patient presented with motor and sensory disorders of the right lower limb,caused by partial damage to the right sciatic nerve.No tumor recurrence was observed at the postoperative appointment.CONCLUSION Histopathological examination of the specimen confirmed the diagnosis of a schwannoma.Thus,laparoscopic surgery is safe and feasible for concomitant extirpation of pelvic schwannomas and other pelvic and abdominal diseases that require surgical treatment.

Minimally invasive reconstruction of extensive mid-lower ureteral strictures using a bilateral Boari flap

Objective:To describe and evaluate the technique using bilateral Boari flap ureteroneocystostomy(BBFUNC)for bilateral mid-lower ureteral strictures.Methods:We retrospectively reviewed five patients who underwent minimally invasive BBFUNC in our institution(Union Hospital,Wuhan,China)between July 2019 and December 2021.The bilateral ureters were mobilized and transected above the stenotic segments.The bladder was isolated and incised longitudinally from the middle of the anterior wall.Then,an inverted U-shaped bladder flap was created on both sides,fixed onto the psoas tendon,and anastomosed to the ipsilateral distal normal ureter.Following double-J stenting,the Boari flaps were tubularized,and the bladder was closed with continuous sutures.The patients’perioperative data and follow-up outcomes were collected,and a descriptive statistical analysis was performed.Results:No case converted to open surgery,and no intraoperative complication occurred.The median surgical time was 230(range 203-294)min.The median length of the bladder flaps was 6.2(range 4.3-10.0)cm on the left and 5.5(range 4.7-10.5)cm on the right side.All patients had not developed recurrent ureteral stenosis during the median follow-up time of 17(range 16-45)months and had a normal maximum flow rate after surgery.The median post-void residual was 7(range 0-19)mL.The maximal bladder capacity was decreased in one(20%)patient.Conclusion:The present study demonstrates that minimally invasive BBFUNC is feasible and safe in treating is limited.

Migration of varicocele coil leading to ureteral obstruction and hydronephrosis:A case report

BACKGROUND Varicocele embolization,a minimally invasive treatment for symptomatic varicoceles,carries a rare risk of complications like ureteral obstruction and hydronephrosis.This case report documents such a case to raise awareness of these potential complications and showcase minimally invasive surgical management as a successful solution.CASE SUMMARY A 35-year-old male presented with flank pain and hematuria following varicocele embolization.Imaging confirmed left ureteral obstruction and hydronephrosis.Laparoscopic ureterolysis successfully removed the embolization coil and repaired the ureter,resolving the patient's symptoms.Follow-up at six months and two years showed sustained improvement.CONCLUSION Minimally invasive surgery offers an effective treatment option for rare complications like ureteral obstruction arising from varicocele embolization.

Re:Minimizing variability:Standardized approach to retroperitoneal single-port robot-assisted ureteral reconstruction

Reconstructive urology,traditionally limited to the lower urinary tract,is now increasingly performed on the upper urinary tract,with better-defined standard out-comes[1].Robotic surgery in urology has expanded beyond oncologic applications,such as prostatectomy,to include pediatrics,urinary diversion,and reconstruction.The field's leading edge is now the combination of robotic approaches in ureteral reconstructive surgery[2].Walasek et al[3].

Minimizing variability:Standardized approach to retroperitoneal single-port robot-assisted ureteral reconstruction

Evidence suggests that robot-assisted ureteroplasty is a safe and feasible management option of ureteral strictures.The retroperitoneal approach to ureteral reconstruction using single-port(SP)robot can be beneficial in challenging cases of patients with prior history of abdominopelvic surgery or radiation.Herein,we present a standardized approach to retroperitoneal SP robot-assisted ureteral reconstruction,highlighting the advantages of this technique in selected clinical scenarios.

Comparison of the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi

Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.

Clinical application of flexible ureteroscopic sheath with controllable intraluminal pressure in treating ureteral stones

Objective:The purpose of the study was to assess the clinical efficacy and safety of a combined perfusion suction platform with pressure feedback control function and an ureteroscopic suction sheath that can measure the ureteropelvic pressure in implementing lithotripsies.Methods:Fifty-two patients who underwent lithotripsy under intelligent monitoring of ureteral intraluminal pressure from June 2016 to January 2018 were retrospectively recruited.The inclusion standard was stone diameter>1.5 cm but<2.5 cm.After the 12/14 Fr suction sheath was placed,manometer interface and suction interface of the sheath were connected to the platform via the pressure sensor and suction tube,respectively.The ureteroscope was connected to the platform perfusion pump,and the crushed stones were aspirated out under negative pressure.Results:According to the location of the stone,21(40.4%)cases were classified as upper ureteral stones,19(36.5%)were midureteral stones,and 12(23.1%)were lower ureteral stones.Forty-seven patients underwent successful primary sheath placement and lithotripsy with a mean operative time of 34.5(standard deviation 18.3)min.Retrograde stone migration did not occur.There were eight patients with hematuria postoperatively.Serious complication was 1.9% with one case of ureteral perforation.Stone clearance was 95.7% at Day 1e2 postoperatively,and 100% at Day 30 postoperatively.Conclusion:Ureteroscopic lithotripsy with intelligent pressure control using our device improved the efficiency of the lithotripsy and rate of stone clearance.The safety of the operation can be ensured.It is worth popularization and application in clinical practice.

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equipments available and the expertise of the operator, we recommend URS as the optimal treatment for distal ureteral calculi. (Asian J Andro12002 Dec, 4: 303-305)

Role of Removing Stasis and Reducing Heat Formula in Clearance of Proximal Ureteral Calculi after Ureteroscopic Ho:YAG Laser Lithotripsy: A Prospective Randomized Study

Objective To prospectively evaluate the efficacy of Removing Stasis and Reducing Heat Formula in accelerating calculus clearance and improving lower urinary tract symptoms of patients with proximal ureteral calculi after ureteroscopic Ho:YAG laser lithotripsy. Methods A total of 138 patients with proximal ureteral calculi underwent ureteroscopic Ho:YAG laser lithotripsy by a single endocrinologist. Stone size varied from 10 to 15 mm. After operation, the patients were randomly divided into three groups: the control group(group A), tamsulosin group(group B), and Removing Stasis and Reducing Heat Formula group(group C). The treatment lasted for 4 weeks or until stone clearance. The primary and secondary outcomes of the three groups at follow-up were assessed. Results Of the 131 patients available for follow-up, 44 cases were in the group A, 45 in the group B, and 42 in the group C, respectively. The stone free rate at 2 weeks in the groups B and C were significantly higher than that in the group A(95.56%, 97.62% vs. 79.55%; all P<0.05). The ureteral colic rate and mean time of fragment expulsion were significantly reduced in the groups B(4.44% and 7.86±4.99 days) and C(2.43% and 6.76±4.37 days) compared with the group A(22.73% and 11.54±9.89 days, all P<0.05). On the day of double-J ureteric stent removal, the group C differed significantly from the group A in the total International Prostate Symptom Score, irritative subscore, obstructive subscore, and quality of life score(all P<0.05). Conclusion Removing Stasis and Reducing Heat Formula in the medical expulsive therapy might be an effective modality for patients with calculus in the proximal uretera after ureteroscopic Ho:YAG laser lithotripsy.

Ureteroscopic Holmium:YAG Laser Lithotripsy for Managing Ureteral Calculi (A Report of 168 Cases)

Summary: The effectiveness and safety of ureteroscopic holmium:YAG laser lithotripsy for managing ureteral calculi was evaluated. Ureteroscopic holmium:YAG laser lithotripsy was performed in 168 ureteral calculi (upper 27 cases, middle 33 cases and lower 108 cases). The results showed that the stone-free rate was 92.6 % in the upper ureteral calculi, 93.9 % in the middle ureteral calculi and 94.4 % in the lower ureteral calculi, respectively. The complication rate was 4.8 % (8 cases). It was suggested that ureteroscopic holmium:YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Novel technique(Ramalingam technique)of port site retrograde intra renal surgery through exteriorized ureter during laparoscopy

Occurrence of significant sized renal calculi along with ureteric pathology is not uncommon.We presented two patients:one with significant sized renal calculi along with lower ureteric stricture,and second case with significant sized renal calculi with primary obstructive mega ureter needing surgery for both the renal calculi and ureteric pathology.In both patients laparoscopy was done,and the ureter was mobilised and divided just above the level of the pathology and exteriorised through the nearest sited port,and retrograde intra-renal surgery(RIRS)was done using flexible ureteroscope and laser.Subsequently laparoscopy was resumed,and ureteric reimplantation directly into the bladder or with a Boari flap was done.The entire procedure was completed in a single stage.This novel technique of exteriorizing the ureter through the laparoscopic port site for flexible ureteroscopy in a case of lower ureteric pathology with renal stone is an advantageous option to manage both pathologies in a single stage.It has a better stone clearance than shock wave lithotripsy and less morbidity than percutaneous nephrolithotomy(PCNL).

Robot-assisted extravesical ureteral reimplantation with ureteral tailoring and dismembering for complex obstructed megaureter

Dear Editor,The advantages of robotic technology including improved dexterity and visualization are particularly evident in challenging reconstructive procedures of the lower urinary tract[1,2].A recent literature review confirmed the feasibility and efficacy of robot-assisted ureteral reimplantation in case of complex anatomy or prior surgery[3].Intra-corporeal ureteral tapering and dismembering are also feasible options using robot-assisted surgery[4].

Evaluation of Extracorporeal Shockwave Lithotripsy in the Management of Renal and Ureteral Calculi

Aim: To evaluate the efficacy of extracorporeal lithotripsy in the management of renal and ureteric calculi in a urology center in Douala, Cameroon. Materials and Methods: This is a retrospective study carried out over six years, between January 2014 and December 2020. All the patients were treated using a Direx Integra lithotripter, with the number of shockwaves ranging from 1200 to 3500, without anaesthesia and were discharged a few hours after the procedure on the same day. In a majority (63.75%) of the cases, the calculi were incidental findings. A Double-J stent was indicated in two patients and preceded extracorporeal lithotripsy because of renal colic and signs of urinary tract infection. Results: We recruited a total of 122 patients with a mean age of 42.19 ± 13.08. We had 65 (53.3%) males and all patients had at least one calculus confirmed by CT scan with a mean size of 13.84 ± 4.17 mm, 85 (69.7%) patients became completely stone-free after a maximum of four sessions of extracorporeal lithotripsy (ESWL). 21 (17.2%) patients had intermediate results, being asymptomatic and/or having less than three residual fragments that measured less than 4 mm. The failure rate was 13.9%, with 17 patients still having more than three fragments measuring more than 4 mm after 4 ESWL sessions. 1 (0.8%) had septic shock as a post ESWL complication while 6 (4.9%) benefitted from a complimentary medical and/or surgical treatment (double J stent placement). Conclusion: The management of renal and ureteral calculi through extracorporeal lithotripsy in adults seems to be particularly effective for renal calculi measuring less than 20 mm and ureteral calculi measuring less than 15 mm. Extracorporeal lithotripsy, which can be performed on an outpatient basis (and without anaesthesia) is associated with minimal complications, and remains the option of choice for most upper urinary tract calculi.

Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi:A case report

BACKGROUND In the clinical treatment of diseases related to ureteral duplication,it is very important to make a clear diagnosis before surgery because different types of ureteral duplication correspond to different treatment options.Inverted Y ureteral duplication with ectopic ureters and multiple urinary calculi is clinically rare.This case can help clinicians increase their understanding of this disease and gain some experience in its diagnosis and treatment.CASE SUMMARY A 36-year-old male who was previously healthy presented to the hospital with lumbar pain.Percussion of the right kidney area showed the patient had pain.Computed tomography scans revealed multiple urinary calculi in the right urinary system.Computed tomography urography revealed a duplicated ureteral malformation with an ectopic ureter.A transurethral ureteroscopic holmium laser lithotripsy was performed successfully.Intraoperative retrograde ureterography was performed,and the ectopic ureter was visible.We informed the family of the intraoperative findings and suggested laparoscopic ectopic ureterectomy for the ectopic ureteral stones.Unfortunately,the family temporarily refused laparoscopic surgery.The patient did not feel any discomfort after one year of followup.CONCLUSION Inverted Y ureteral duplication with an ectopic ureter and multiple urinary calculi is rare.Clinicians must be highly vigilant,make a correct diagnosis before surgery,determine the type of ureteral duplication and the distribution of urinary calculi,and then draw up a reasonable treatment plan to avoid unnecessary complications.

Dissolution of Ureteral Uric Acid Calculi with Local Litholytic Irrigation

This study was designed to evaluate the efficacy of local litholytic irrigation (LLI) in the treatment of ureteral uric acid calculi. Fourteen cases of ureteral uric acid calculi were diagnosed by abdominal plain radiography (KUB),retrograde urography,ultrasonography(B-mode ultrasound),spiral computerized tomography(CT) and blood biochemical examinations. A ureteral catheter was passed retrogradely across ureteral calculi by cystoscopy. LLI with tromethamine-E(THAM-E) was performed via the ureteral catheter after the improvement of renal function and general situation and the control of urinary tract infection under the condition of intravenous application of antibiotics. The irrigation rate varied from 1000 to 1500 ml per day. Retrograde pyelography demonstrated complete dissolution of all the stones,13 cases within 10 days and 1 within 12 days. Mild hematuria was observed in the majority of the cases and temporary aggravated lumbago in 1 case,with no other side effects. It is concluded that LLI is a practical and effective method in the treatment of ureteral uric acid calculi for its advantages of shorter duration,lower cost,less physical suffering and no severe complications.

Changes of serum β2-MG, Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance

Objective:To investigate the changes of serumβ2 microglobulin(β2-MG),cystatin C(CysC)and urine microalbumin(mAlb)levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy and their clinical significance.Methods Sixty-eight patients with ureteral calculi admitted to the hospital between June 2018 and June 2019 were selected as the observation group.35 volunteers who received physical elimination in the hospital during the same period were selected as the control group.Levels ofβ2-MG,Cys C and urine mAlb in the observation group were compared before and after treatment,and compared with those in the control group.Changes in serumβ2-MG,Cys C and urine mAlb levels and renal function indicators[blood urea nitrogen(BUN),serum creatinine(SCr)]in patients with different prognosis in the observation group after treatment were analyzed.The value of serumβ2-MG,Cys C and urine mAlb levels in the diagnosis and treatment of ureteral calculi was analyzed with ROC curve.The correlations between serumβ2-MG,Cys C and urine mAlb levels and renal function indexes were analyzed.Results Serumβ2-MG,Cys C and urine mAlb levels in the observation group before treatment were significantly higher than those in the same group after treatment or those in the control group(P<0.05).Serumβ2-MG,Cys C and urine mAlb levels,BUN and SCr in patients with residual stones were significantly higher than those in patients without(P<0.05).ROC curve analysis showed that the sensitivity and the area under the curve of combined detection of serumβ2-MG,Cys C and urine mAlb levels for evaluating the curative effect of extracorporeal shock wave lithotripsy on ureteral calculi were significantly higher/larger than those of single detection of the three(P<0.05).Partial correlation analysis showed that serumβ2-MG,Cys C and urine mAlb levels were positively correlated with BUN and SCr(P<0.05).Conclusion There are obvious changes of serumβ2-MG,Cys C and urine mAlb levels in patients with ureteral calculi before and after extracorporeal shock wave lithotripsy.The combined detection of the three indexes is helpful for the early diagnosis of ureteral calculi and the evaluation of renal function after lithotripsy.They can provide reference for protecting renal function in patients with ureteral calculi treated by extracorporeal shock wave lithotripsy.

Effectiveness of Medical Management in Spontaneous Expulsion of Lower Ureteral Calculi: A Prospective Study

Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Materials and Methods: A total of 100 consecutive symptomatic patients with stones located in the Lower ureter were selected for the study who received oral tamsulosin 0.4 mg daily for 4 weeks and deflazocort 30 mg daily for 10 days and diclofenac IM/Oral on demand. Ultrasound follow-up and medical visits and X ray KUB were performed weekly for 4 weeks. Stone passage rate and time, pain episodes and endoscopical intervention were evaluated. Results: The stone expulsion rate was 87.8%. Mean stone size was 6.5 ± 2.14 mm. Mean expulsion time was 8 ± 1.84 days. Mean pain episodes were 1.50 ± 0.87 days. 11 patients needed intervention for stone retrieval. There was no statistically significant difference between the expulsion rates of right and left ureteral stones (P value = 0.31). Conclusions: Medical therapy with a combination of α1 adrenergic blocker and corticosteroid achieve good stone expulsion rates, lower pain episodes and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy.

Effects of RIRS and Mini-PCNL on liver and kidney function,endocrine changes and trauma in patients with upper ureteral calculi

Objective: To investigate the effects of retrograde intrarenal surgery (RIRS) and Mini-percutaneous nephroscope lithoipsy (Mini-PCNL) on liver and kidney function, endocrine changes and trauma in patients with upper ureteral calculi. Methods: 100 patients with upper ureteral calculi admitted to our hospital from March 2016 to February 2018 were selected. They were randomly divided into observation group (RIRS group) and control group (Mini-PCNL group), with 50 cases in each group. The observation group was given RIRS, while the control group was given Mini-PCNL. At the same time, the expression levels of the liver function [including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma transpeptidase (gamma-GT)], renal function [including urea nitrogen (BUN) and serum creatinine (Scr) levels], endocrine changes [including corticotropin (ACTH), cortisol (Cor), norepinephrine (NE)] and trauma related indexes [Including soluble vascular cell adhesion molecule-1 (sVCAM-1) and erythrocyte sedimentation rate (ESR)] were analyzed and compared between the two groups. Results: There was no significant difference in ALT, AST, γ-GT, BUN and Scr before and after operation between the two groups. The difference was not statistically significant (P>0.05). After operation, the levels of ACTH (27.37±3.29) pg/mL, Cor (150.09±18.47) ng/mL, NE (165.48±26.74) ug/L and sVCAM-1, (596.55±56.24) ng/mL in RIRS group were significantly lower than those in Mini-PCNL group ((38.42±4.33) pg/mL, (222.37±28.70) ng/mL, (287.26±25.29) ug/L and (820.62±72) mL)The differences were statistically significant (P<0.05). While the ESR level in RIRS group (8.29±0.63) mm/h was significantly higher than that in Mini-PCNL group (7.16±0.68) mm/h, and the differences were statistically significant (P<0.05). Conclusions: There is no significant difference in the liver and renal function between RIRS and Mini-PCNL in the treatment of upper ureteral calculi. RIRS can better improve the endocrine status of patients and reduce the damage of the body, which is a more ideal way of operation.

The role of ureteroscopy for treatment of staghorn calculi: A systematic review

Objective:To define the role of ureteroscopy for treatment of staghorn calculi.Methods:A systematic review was conducted using the Scopus and Medline databases.Original articles and systematic reviews were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.Only studies relating to the role of ureteroscopy for treatment of staghorn calculi were included.Results:In five studies on ureteroscopic monotherapy,stone-free rate(SFR)ranged from 33%to 93%,with a maximum four ureteroscopy sessions per patient and no major complications.Endoscopic combined intrarenal surgery(ECIRS)was compared with percutaneous nephrolithotomy(PNL)in two studies and reached significantly higher SFR(88%e91%vs.59%e65%)and lower operative times(84e110 min vs.105e129 min).The role of salvage ureteroscopy for residual stones after primary PNL has been highlighted by two studies with a final SFR of 83%e89%.One study reported on the feasibility of ureteroscopy for ureteral stones and same-session PNL for contralateral staghorn calculi,with a SFR of 92%.Conclusion:Ureteroscopy plays a pivotal role in the setting of a combined approach to staghorn calculi.Ureteroscopy is also particularly suitable for clearance of residual stones.In specific cases,ureteroscopy may become the sole applicable therapeutic option to staghorn calculi.Technological advances and refinement of techniques suggest a major role of ureteroscopy for staghorn calculi treatment in close future.