Mastering large lower calyceal stones treatment: Use of six essential tips and tricks for flexible ureteroscopy versus in situ laser lithotripsy: A prospective randomized controlled study.

PURPOSE: Lower calyceal stones are more challenging to treat due to their anatomical position and consequences. Therapies such as Extracorporeal Shock Wave Lithotripsy and Percutaneous Nephrolithotomy often offer limited efficacy or involve significant complications. This study aimed to assess the safety and effectiveness of advanced Flexible Ureteroscopy using six specific techniques compared to conventional in situ laser lithotripsy for large lower calyceal stones 10-25 mm.

METHODOLOGY: Prospective Randomized Controlled Study Design, in which 104 patients were divided into two groups. Group A underwent FURS with six specific (tips & tricks) including Modified T-tilt position (45° Trendelenburg position, 45° lateral tilt opposit the stone side ), bendable access sheaths with suction, modern laser techniques (combination of dusting & pop-corn) using dormia basket to move the stone to renal pelvis or to align the stone with the laser if it was too large to remain in the calyx plus using thin flexible ureteroscopy 7 FR for easy maneuverability and constant irrigation to maintain visibility. Conventional in situ laser lithotripsy was performed for Group B. The primary measure was the stone-free status with analysis of operative time, complications, hospital stay, and further treatments needed and recovery.

RESULTS

The stone-free rate was found to be better in Group A 90.38% compared to Group B 71.15% with p-value 0.025. The median operative time for Group A was longer than Group B, with a median operative time of 78 min. which statistically significant (p < 0.001). Study reports better overall outcomes for Group A, including higher stone-free rate and lower need for additional interventions.

CONCLUSION

Analysis of the techniques shows that their application significantly improves stone clearance rates increases the efficiency of stone removal without increasing risk of complications. These findings support integrating innovative strategies into routine clinical practice.