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Ureteroscopy is recognized as a minimally invasive and readily accessible method with low morbidity, favorable outcomes, and rapid post-interventional recovery. Recent advancements in rigid and flexible ureteroscopes have enhanced their efficiency, durability, and capability to accommodate accessory instruments. In this retrospective analysis, we evaluated 75 consecutive patients with large renal stones (stone burden between 2 and 4 cm) treated using a combination of semirigid and flexible ureteroscopy between January 1, 2020, and December 31, 2021. Stone properties and anatomical information were collected from the image archives derived from computed tomography (CT) and/or KUD radiography. Multiple ureteroscopy sessions were required for bigger stones. The length of the hospital stay, operation time, stone-free rate, preoperative and postoperative complications, and complication rates were examined. The average age of the patients was 52.7 years, with a mean stone burden of 31.45 mm. Most stones were in the renal pelvis, followed by the upper calyx. The average operative time was 56.2 minutes. After the initial ureteroscopy session, the stone clearance rate was 76%, which increased to 92% after two ureteroscopy sessions. Complication rates were evaluated using the Clavien-Dindo modified system, with an overall complication rate of 18.4%. Most of the complications were Clavien Grades I and II, with no grade V complication encountered. Large renal stones can be treated by combining semirigid and flexible ureteroscopy to reduce the operative time and protect the flexible ureteroscope. [ABSTRACT FROM AUTHOR]

Introduction: After advances in flexible ureteroscopes' design, accessories, and lithotripters, flexible ureteroscope has been used widely for the treatment of large renal calculi >2 cm. Objectives: The objective was to evaluate the role of flexible ureteroscopy with laser lithotripsy in the treatment of large renal calculi >2 cm and find out which factor can affect the results. Patients and Methods: Prospectively, we have studied 47 patients who have passed through flexible ureteroscopy with laser lithotripsy for renal calculi >2 cm. Preoperative, operative, and postoperative data were recorded. Results and complications were recorded, too. Results: In 47 patients, the mean stone size is 26.2 ± 4.1 cm and the total stone-free rate (SFR) is 89.4%, while in stone size ≤3 cm, the SFR is 90.7%, and for stone size >3 cm, the SFR is 75%. Overall stone density is 1020 ± 286 HU. The SFR is 95.5% in stones ≤1000 HU and 84% in stones >1000 HU. The mean operative time is 99.2 ± 29.3 min. The intraoperative complications are 17%, while postoperative complications are 36% and all complications are mild. Conclusion: Flexible ureterorenoscopy (FURS) is safe and effective for the treatment of large renal calculi >2 cm. Stones >3 cm may have lower results even after staged therapy.

Introduction: After advances in flexible ureteroscopes' design, accessories, and lithotripters, flexible ureteroscope has been used widely for the treatment of large renal calculi >2 cm. Objectives: The objective was to evaluate the role of flexible ureteroscopy with laser lithotripsy in the treatment of large renal calculi >2 cm and find out which factor can affect the results. Patients and Methods: Prospectively, we have studied 47 patients who have passed through flexible ureteroscopy with laser lithotripsy for renal calculi >2 cm. Preoperative, operative, and postoperative data were recorded. Results and complications were recorded, too. Results: In 47 patients, the mean stone size is 26.2 ± 4.1 cm and the total stone-free rate (SFR) is 89.4%, while in stone size ≤3 cm, the SFR is 90.7%, and for stone size >3 cm, the SFR is 75%. Overall stone density is 1020 ± 286 HU. The SFR is 95.5% in stones ≤1000 HU and 84% in stones >1000 HU. The mean operative time is 99.2 ± 29.3 min. The intraoperative complications are 17%, while postoperative complications are 36% and all complications are mild. Conclusion: Flexible ureterorenoscopy (FURS) is safe and effective for the treatment of large renal calculi >2 cm. Stones >3 cm may have lower results even after staged therapy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the outcomes of retrograde intrarenal surgery (RIRS) for large renal calculi, and to identify factors that influence the stone-free rate after RIRS for renal stone burden greater than 2 centimeters. Materials and Methods: This retrospective chart review included patients who underwent RIRS for renal calculi greater than 2 centimeters in size during January 2015 to December 2016 at Siriraj Hospital Thailand's largest national tertiary referral center. Data were collected and compared between those having and not having residual stones greater than 2 cm in diameter. Results: The present study included 100 eligible cases. The most common site was at lower calyces (42%). The mean stone burden size was 31.43 mm (range: 20 to 140). The average operative time was 62 minutes (range: 20 to 150), and the mean hospital length of stay was 2.7 days (range: 1 to 22). The most common stone composition was calcium oxalate monohydrate (37%), followed by calcium phosphate (23%). The success rate was 84% and 94% after the 1st session and 2nd session of RIRS, respectively. The factors that were found to predict residual stone after RIRS were stone burden greater than 35 mm in size (odds ratio [OR]: 5.86, 95% confidence interval [CI]: 1.77 to 19.57; p = 0.004) and lower pole location (OR: 1.97, 95% CI: 1.039 to 3.742; p = 0.038). Sepsis was found in 6 patients, all of whom were successfully treated with intravenous antibiotic, except for one mortality in an immunocompromised patient. Conclusion: RIRS is a promising treatment option for renal calculi with large stone burden. Large kidney stones (>2 cm) can be treated with high success rate and low morbidity. The most significant predictors of residual calculi are stone burden more than 35 millimeters in size and lower pole location. [ABSTRACT FROM AUTHOR]

Objective: Our primary aim is to perform the external validation of the current scoring systems in predicting stone-free status (SFS) after retrograde intrarenal surgery (RIRS) for renal stones 2-4 cm and develop a novel scoring system by re-examining possible predictive factors related to SFS., Methods: Patients who underwent RIRS due to renal stones with a cumulative stone diameter of 2-4 cm between January 2017 and March 2021 were retrospectively screened. Residual stones ≤2 mm were defined as clinically insignificant, and these cases were considered to have SFS. Possible predictive factors related to SFS were examined using the multivariate logistic regression analysis. A nomogram and a scoring system were developed using independent predictive variables. The prediction ability of the previous and the new scoring system were evaluated with the ROC analysis., Results: The existing scoring systems were found to be insufficient in predicting SFS (AUC < 0.660 for all). The independent predictors of SFS were identified as stone surface area (OR: 0.991, p < 0.001), stone density (OR: 0.998, p < 0.001), number of stones (OR: 0.365, p = 0.033), and stone localization (p = 0.037). Using these predictive markers, a new scoring system with a score ranging between 4 and 15 was developed. The AUC value for this scoring system was 0.802 (0.734-0.870)., Conclusion: The RUSS, S-ReSC and R.I.R.S. scoring systems and Ito's nomogram failed to predict SFS in stones >2 cm. The SFS predictive ability of our new scoring system was higher in >2 cm stones compared to the other scoring systems., (Copyright © 2022. Published by Elsevier España, S.L.U.)

Aims: To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden. Patients and methods: A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28 years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940 mm. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24 Ch or 26 Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper. Results: No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit. Conclusions: Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones. [ABSTRACT FROM AUTHOR]