Flexible Ureteroscopy Research Articles

Predicting Urinary Stone Composition in Single-Use Flexible Ureteroscopic Images with a Convolutional Neural Network.

Background and Objectives: Analysis of urine stone composition is one of the most important factors in urolithiasis treatment. This study investigated whether a convolutional neural network (CNN) can show decent results in predicting urinary stone composition even in single-use flexible ureterorenoscopic (fURS) images with relatively low resolution. Materials and Methods: This study retrospectively used surgical images from fURS lithotripsy performed by a single surgeon between January 2018 and December 2021. The ureterorenoscope was a single-use flexible ureteroscope (LithoVue, Boston Scientific). Among the images taken during surgery, a single image satisfying the inclusion and exclusion criteria was selected for each stone. Cases were divided into two groups according to whether they contained any calcium oxalate (the Calcium group) or none (the Non-calcium group). From 506 total cases, 207 stone surface images were finally included in the study. In the CNN model, the transfer learning method using Resnet-18 as a pre-trained model was used, and only endoscopic digital images and stone classification data were input to achieve minimally supervised learning. Results: There were 175 cases in the Calcium group and 32 in the Non-calcium group. After training and validation, the model was tested using the test set, and the total accuracy was 81.8%. Recall and precision of the test results were 88.2% and 88.2% in the Calcium group and 60.0% and 60.0% in the Non-calcium group, respectively. The area under the receiver operating characteristic curve of the model, which represents its classification performance, was 0.82. Conclusions: Single-use flexible ureteroscopes have financial benefits but low vision quality compared with reusable digital flexible ureteroscopes. As far as we know, this is the first artificial intelligence study using single-use fURS images. It is meaningful that the CNN performed well even under these difficult conditions because these results can further expand the possibilities of its use.

Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm.

Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.

Retracted: Flexible Ureteroscopy and Nephroscopy for Stone Removal in Patients with Multiple Renal Calculi.

[This retracts the article DOI: 10.1155/2022/2078979.].

Intrarenal pressures during flexible ureteroscopy: aninsight into safer endourology.

To assess intrarenal pressures (IRPs) and complication rates after flexible ureteroscopy (fURS), and to assess factors that contribute to raised IRPs and postoperative complications. After informed consent patients underwent fURS under general anaesthesia. The transducer of a 0.3556 mm (0.014″) pressure guidewire was placed in the renal pelvis for live recording of IRPs. The fURS procedures were performed in a routine manner under antibiotic cover with the aim of dusting the calculus to completion. The operating surgeon was blinded to the live-recorded IRPs. A total of 40 fURS procedures were performed in 37 patients (26 male and 11 female). The mean age was 50.5 years. As a cohort, the mean of average IRPs was 34.8 mmHg and the mean of maximal IRPs was 128.8 mmHg. Pearson's correlation showed a significant inverse correlation between the mean IRP and age (r[38]: -0.391, P = 0.013). Three cases experienced postoperative deviations from uncomplicated recovery, with two being hypotensive and one case being both hypotensive and hypoxic. Three cases returned to the emergency department within 30 days of surgery, with two cases of flank pain and one case of urosepsis with positive urine cultures. The patient presenting with urosepsis had exhibited IRPs exceeding the mean. The IRPs changed significantly from normal baseline levels during routine fURS. The mean IRP during fURS correlates with patient age, but not with other factors. The IRP may be related to increased complication rates at fURS. Understanding factors that influence IRP will allow urologists to better manage this intraoperatively.

Comparative analysis of unilateral and bilateral flexible ureterorenoscopy: a cohort multicentre study

Introduction. Flexible ureteroscopy (fURS) with laser lithotripsy is the «gold standard» for minimally invasive treatment in patients with kidney stones less than 20 mm. Currently, there are no objective data on the efficacy and safety of bilateral interventions.Objective. To study the results of bilateral flexible URS (B-fURS) versus unilateral flexible URS (U-fURS).Materials & methods. Eighty patients prospectively enrolled in the study from July 2022 to December 2022 and was divided into 2 groups. Group 1 (n = 40) underwent U-fURS and Group 2 (n = 40) underwent B-fURS. A single stone up to 20 mm or multiple small calyx stones was an indication for the operation. The baseline values were comparable between the groups, but in the B-fURS group a 39.0% higher incidence (p > 0.002) of multiple stones and a 28.0% higher incidence (p > 0.001) of stones in the lower pole. Previous interventions were also more frequent in Group 1 (B-fURS) patients.Results. Stone-free rate did not differ (p > 0.9) between the groups and was 95.0% and 97.5%, respectively. No serious complications (p > 0.9) of Clavien III–V were observed in both groups.Conclusion. Bilateral flexible ureteroscopy is a safe and effective option for patients with bilateral kidney stones, allowing removal of stones in one anesthesia on both sides.

Single use flexible ureteroscopes: Current status and future directions.

Single use ureteroscopes are a technological innovation that have become available in the past decade and gained increased popularity. To this end, there are now an increasing number of both benchside and clinical studies reporting outcomes associated with their use. Our aim was to deliver a narrative review in order to provide an overview of this new technology. A narrative review was performed to gain overview of the history of the technology's development, equipment specifications and to highlight potential advantages and disadvantages. Findings from preclinical studies highlight potenial advantages in terms of the design of single use ureteroscopes such as the lower weight and more recent modifications such as pressure control. However, concerns regarding plastic waste and environmental impact still remain unanswered. Clinical studies reveal them to have a non inferior status for outcomes such as stone free rate. However, the volume of evidence, especially in terms of randomised trials remains limited. From a cost perspective, study conclusions are still conflicting and centres are recommended to perform their own micro cost analyses. Most clinical outcomes for single use ureteroscopes currently match those achieved by reusable ureteroscopes but the data pool is still limited. Areas of continued debate include their environmental impact and cost efficiency.

Multistaged retrograde intrarenal surgery for large renal stones – our institutional experience

Background: Recent advances such as retrograde intrarenal surgery (RIRS) have become an acceptable and widespread technique for upper urinary tract stone management. However, the outcome and complication of staged RIRS for large stone burden (>2.0) still needs to be reported. A total of 150 cases of renal calculi were treated by RIRS in a single center. Among these, 30 had renal stone size larger than 2.0 cm. Aims and Objectives: This study was conducted to present our views, experience, and outcomes of Retrograde Intra Renal Surgery for the Management of Large Renal Stones in Staged Manner using Flexible Ureteroscope with Holmium Laser as energy Source. Materials and Methods: Between March 2020 and January 2022, we admitted 150 patients with upper urinary tract stones who underwent RIRS using 30 Watt Holmium laser lithotripsy in our institute. Post-surgery, all the cases are evaluated in terms of stone free rates (SFR) complications and effectiveness of RIRS. Results: A total of 150 patients having upper urinary tract stones were included in this study (84 male and 66 female patients). All patients underwent RIRS using 30 watt holmium laser lithotripter. The overall SFR was 90.6%. The average stone size was 1.1 cm with average operation time of 100.6 min. Average hospital stay was 2.2 days. The average pain score was 2.1/10 by the Numerical Rating Scale. No major complications (Clavien Dindo III- V) were noted in the study groups. Conclusion: Through our study, we concluded that RIRS for large renal stone management is an effective and safe treatment modality currently.

LithoVue Elite Compared With Single-Use and Reusable Ureteroscopes: A Bench and Human Cadaver Study

Purpose: To compare the attributes of the next-generation LithoVue Elite (LVE, Boston Scientific Corporation) with current state-of-the-art single-use and reusable flexible ureteroscopes. Methods: LithoVue Elite is the latest single-use flexible ureteroscope with improved functionality and a novel ability to measure intrarenal pressure. In this study, we compare LVE with 3 single-use ureteroscopes (Pusen, WiScope, and Anqing) and 1 reusable ureteroscope (Olympus). A bench model was used to measure the physical characteristics (tip deflection and irrigation) and image quality (resolution, color accuracy, field of view, and latency). A human cadaveric model was used to score the maneuverability and ergonomics. This abstract shows the least square means from multiway ANOVAs used for analysis. Results: The ureteroscopes showed a tip deflection ranging from 243° to 306° with LVE at 279°. The irrigation rates ranged from 28 to 44 mL/min with LVE at 40 ml/min. LVE had a resolution of 6.34 line pair/mm, while the other scopes ranged from 4.86 to 5.77 line pairs/mm. The color accuracy was quantified with Delta E, an image analysis variable, which ranged from 14 to 42 with LVE at 28. The field of view ranged from 55° to 89°, and LVE was at 89°. The image latency ranged from 41 to 92 ms with LVE at 58 ms. Finally, the maneuverability scores ranged from 3.8 to 4.1 of 5 with LVE scoring 4.1 while the ergonomics scores ranged from 2.4 to 4.8 with LVE scoring 4.4. Conclusion: LithoVue Elite had above average performance compared with single-use and reusable ureteroscopes and upper-range scores for resolution, field of view, maneuverability, and ergonomics. Accordingly, LVE shows promise; however, further research is needed to assess the impact of intrarenal pressure on the standard of care.

Shockwave Lithotripsy for De-Novo Urolithiasis after Kidney Transplantation: A Systematic Review of the Literature.

Allograft urolithiasis is an uncommon, challenging, and potentially dangerous clinical problem. Treatment of allograft stones includes external shockwave lithotripsy (SWL), flexible ureteroscopy and lasertripsy (fURSL), or percutaneous nephrolithotomy (PCNL). A gap in the literature and guidelines exists regarding the treatment of patients in this setting. The aim of this systematic review was to collect preoperative and treatment characteristics and evaluate the outcomes of post-transplant SWL for stone disease. A systematic search in the literature was performed, including articles up to March 2023. Only original English articles were selected. Eight articles (81 patients) were included in the review. Patients were mainly male, with a mean age of 41.9 years (±7.07). The mean stone size was 13.18 mm (±2.28 mm). Stones were predominantly located in the kidney (n = 18, 62%). The overall stone-free rate and complication rates were 81% (range: 50-100%) and 17.2% (14/81), respectively, with only one major complication reported. A pre-operative drainage was placed in eleven (13.5%) patients. Five patients (6.71%) required a second treatment for residual fragments. SWL is a safe and effective option to treat de novo stones after transplantation. Larger studies are needed to better address allograft urolithiasis management.

Development of an Automated Composite Ureteroscopic Efficiency Score Through Simulated Ureteroscopic Skills Assessment.

Introduction: Flexible ureteroscopy (fURS) is the most common procedure for treatment of urolithiasis. We previously utilized kinematic evaluations of simulated fURS to demonstrate that certain body movements are associated with efficient ureteroscopic manipulation for complex tasks. In this study, we incorporated computer vision to create an efficiency score using the ureteroscope travel distance (DIST), task time (TIME), spectral arc length (SPARC), and percentage of purposeful wall collisions (COLL). The goal is a simulation-based system that can abstract these automated performance metrics (APMs) to differentiate between novice and expert ureteroscope handling. Methods: A ureteroscopic simulation box was used. Body kinematics, task time, and ureteroscopic movements were analyzed using a motion capture system and video camera. Optical flow computer vision was used to track the ureteroscope. DIST, TIME, and SPARC were automatically calculated. Wall collisions were automatically captured and independently judged by two authors; an algorithm was developed to automatically determine the COLL variable. A mixed-effects model was used to aggregate these variables and distinguish between surgeons' first and final task attempts. Normalized values of these metrics were added to create a composite ureteroscopic efficiency score (CUES). Results: Twelve urologists completed the simulated tasks. The COLL assessment algorithm determined beneficial wall collisions with an accuracy of 77%. Normalized values of TIME, DIST, SPARC, and COLL were combined to create a composite ureteroscopic efficiency score (CUES). Compared with the first attempt, both the second and third attempts showed statistically significant improvements in CUES. The ROC-AUC score reached 0.86, suggesting excellent discrimination between attempts. There was also a statistically significant difference in CUES when comparing resident and attending performance. Conclusions: APMs can be abstracted using computer vision and artificial intelligence; an aggregate composite score (CUES) may be a promising method for evaluation of ureteroscopic efficiency.

Does gender influence retrograde intrarenal surgery (RIRS) outcomes? Data from the Flexible Ureteroscopy Outcomes Registry (FLEXOR)

Introduction and objectivesAs well established flexible ureteroscopy (RIRS). There is still no evidence if gender can have any influence on the outcomes and complication when performing. This study aims to evaluate the role that gender has in performing flexible ureteroscopy from a large series of patients. MethodsThis study retrospectively analyzed patients who underwent RIRS for renal stones from January 2018 to August 2021 within the multicentric FLEXOR registry. Demographics, stone characteristics, perioperative findings, results and complications were analyzed and compared between gender groups. ResultsA total of 6669 patients were included, 66.1% were male and 33.9% were female. Stone characteristics was comparable between groups. Female patients had significant higher fever and positive urine culture rates (12% vs. 8% and 37% vs. 34%). Also, females had a slight longer hospital stay (3.8 vs. 3.5 days; P < 0.001) and more residual fragments after the procedure (23.03% vs. 20.97 (P = 0.032). Overall complications were slightly significantly higher in women (15.74% vs. 14% (P = 0.042)) mainly at the expense of fever rates (6.9% vs. 5.7%) whereas the risk of sepsis was similar in both groups. A multivariate analysis showed that larger stone size, multiple and lower pole stones seem to have a negative impact in the incidence of residual stones and complications. ConclusionOur real life global study reflects that female gender may have a correlation with a slightly increased residual fragment rate and overall low grade complications. However, women can safely be treated with RIRS with no increased the rate of sepsis with appropriate care.

Effect of Sanjin Paishi Decoction combined with lithotripsy on clinical symptoms and renal function of patients with nephrolithiasis

Purpose: To determine the effect of Sanjin Paishi decoction (SJPSD) combined with lithotripsy on the improvement of clinical symptoms and renal function in nephrolithiasis patients.&#x0D; Methods: A total of 100 patients with nephrolithiasis, who were treated in the outpatient department of the Affiliated Hospital of Jinggangshan University, Ji'an, Jiangxi, China from January 2019 to October 2021, were retrospectively analyzed and enrolled in the study. They were divided into control group (CG, n = 40) treated with holmium laser lithotripsy through flexible ureteroscope, and a study group (OG, n = 60) treated with SJPSD after holmium laser lithotripsy through flexible ureteroscope. Treatment effect and improvement in renal function indices (serum creatinine (Scr), cystatin C (CysC) and urinary N-acetyl-β-D glucosaminidase (NAG)), were compared. Postoperative clinical efficacy, time of disappearance of hematuria, postoperative extubation time, of hospital stay, Traditional Chinesemedicine (TCM) symptom score, and the incidence of complications were evaluated.&#x0D; Results: After treatment, OG showed significantly downregulated Scr, CysC, and NAG compared with CG, but the total clinical effectiveness was significantly higher than that of CG (p &lt; 0.05). Kidney stone clearance rate of OG was higher than that of CG at 4 weeks post-operation (p &lt; 0.05). The time of disappearance of postoperative hematuria, postoperative extubation time, and hospitalization time ofOG was shorter than those of CG, while TCM symptom scores were lower than those in CG (p &lt; 0.05).&#x0D; Conclusion: The combination of SJPSD and holmium laser lithotripsy in the management of patients with renal calculi results in improvement in clinical efficacy, reduction in TCM symptom scores, and speed-up postoperative recovery, without increase in the incidence of complications. Prospective studies and long-term follow-up are anticipated in the future. Furthermore, established animal or in vitro models are required to determine the specific mechanism of action.

Role of virtual reality in improving the spatial perception of the kidney during flexible ureteroscopy: A feasibility study using virtual reality simulators and 3D models.

The aims were to describe a software-based reconstruction of the patient-specific kidney cavity intraluminal appearance via a head-mounted device and to estimate its feasibility for training novices. In total, 15 novices were recruited. Each novice was shown a three-dimensional reconstruction of a patient's computed tomography scan, whose kidney was printed. They then joined the surgeon in the operating room and assisted them in detecting the stone during flexible ureteroscopy on the printed model. Then, each participant did a 7-day virtual reality (VR) study followed by virtual navigation of the printed kidney model and came to the operating room to help the surgeon with ureteroscope navigation. The length of the procedure and the number of attempts to find the targeted calyx were compared. With VR training, the length of the procedure (p = 0.0001) and the number of small calyces that were incorrectly identified as containing stones were significantly reduced (p = 0.0001). All the novices become highly motivated to improve their endourological skills further. Participants noticed minimal values for nausea and for disorientation. However, oculomotor-related side effects were defined as significant. Five specialists noticed a good similarity between the VR kidney cavity representation and the real picture, strengthening the potential for the novice's education via VR training. Virtual reality simulation allowed for improved spatial orientation within the kidney cavity by the novices and could be a valuable option for future endourological training and curricula.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

Feasibility of urolithiasis management after studer neobladder urinary diversion: A multicenter center study

Background: Stones formation is a common complication after cystectomy including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Aims and Objectives: Feasibility of urolithiasis management after urinary diversion surgery. Materials and Methods: Eleven patients of diversion with stone were observed from January 01, 2015, to July 30, 2022. Operative procedures were decided on basis on stone locations and size. Perioperative parameters were observed and compared with similar studies. Percutaneous nephrolithotomy, percutaneous-based antegrade ureteroscopy with semi-rigid or flexible ureteroscope, transurethral reservoir lithotripsy, percutaneous pouch lithotripsy, and open operation were performed. The operative finding and complications were retrospectively collected and analyzed. Results: The mean age of the patients was 53.2±8.1 years and mean pre-operative stone diameter was 3.1±3.5 cm. Three patients suprapubic cystolithotomy, two patients percutaneous cystolithotripsy, two patients percutaneous nephrolithitomy, two patients extracorporeal shock wave lithotripsy, one patient per urethral cystolithotripsy/cystolitholapexy, and one patient ureteroscopy/flexible ureteroscopy were done. The male-to-female ratio was 9/2. Stone-free rate was 100% after single session of treatment. In the post-operative period, fever was observed in two patients, and urinary leakage through wound site in one patient. Conclusion: Stone surgery after urinary diversion is challenging, success of treatment depends on experience of surgical team, pre-operative preparation, and correct instrumentations.

Bladder Postoperative Spindle Cell Nodule: Malignant Mimicry in the Postoperative Setting

Bladder Postoperative Spindle Cell Nodule: Malignant Mimicry in the Postoperative Setting

Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?

Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.

Influence of pre-stenting on RIRS outcomes. Inferences from patients of the Global Multicentre Flexible Ureteroscopy Outcome Registry (FLEXOR).

Retrograde Intrarenal Surgery (RIRS) is recommended as an alternative to percutaneous nephrolithotomy for stones up to 2 cm. Pre-stenting before RIRS remains controversial with various studies differing in outcomes and recommendations. We aim to understand how pre-stenting influences surgical outcomes. A number of 6579 patients from the TOWER group registry were divided into pre-stented (group 1) and non-pre-stented groups (group 2). Patients aged ≥18 years old, with normal calyceal anatomy were enrolled. Patients with ureteric stones, anomalous kidneys, bilateral stones, planned for ECIRS were excluded. Patients are homogeneously distributed in both groups (3112 vs. 3467). The predominant indication for pre-stenting was symptom relief. Overall stone size was comparable, whilst group 1 had a significantly more multiple (1419 vs. 1283, P<0.001) and lower-pole (LP) stones (1503 vs. 1411, P<0.001). The mean operative time for group 2 was significantly longer (68.17 vs. 58.92, P<0.001). Stone size, LP stones, age, recurrence and multiple stones are contributing factors for residual fragments at the multivariable analysis. The incidence of postoperative day 1 fever and sepsis was significantly higher in group 2, indicating that pre-stenting is associated with a lower risk of post-RIRS infection and a lower overall complications rate (13.62% vs. 15.89%) (P<0.001). RIRS without pre-stenting can be considered safe without significant morbidity. Multiple, lower-pole and large stone is a significant contributor towards residual fragments. Patients who were not pre-stented had significantly higher but low-grade complications, especially for lower pole and large volume stones. While we do not advocate routine pre-stenting, a tailored approach for these patients should include proper counselling regarding pre-stenting.

Considerations for Percutaneous Nephrolithotomy in Transgender Female Patients

Clinical History: A 38-year-old transgender female with history of HIV, bilateral orchiectomy, bilateral breast and buttock augmentation, and kidney stones presented for surgical evaluation of right nonobstructing kidney stones. CT scan showed two nonobstructing stones in the right lower pole measuring 8 and 7 mm. She specifically requested no ureteral stent and nonprone positioning because of recent facial plastic surgery. She elected to proceed with supine minipercutaneous nephrolithotomy (PCNL). There are several special considerations that should be taken when performing PCNL on transgender patients. Physical Examination: NAD, AAOx3. Abdomen was soft, nontender, and negative for costovertebral tenderness. Diagnosis: Right lower pole nonobstructing kidney stones. Intervention: A supine mini-PCNL was performed to accommodate patient's recent facial surgery and aversion to ureteral stent placement. In the Galdakao-modified Valdivia supine position, access was obtained using combined fluoroscopic, ultrasound, and endoscopic approaches. Access site was dilated to 18F, and the stones were extracted without incident. A retrograde flexible ureteroscope was used to evaluate all calices and confirm that no additional stones were present. A 14F nephrostomy tube was placed and no ureteral stent was left. Follow-up: Patient effectively underwent surgery without complication and was sent to post-anesthesia care unit (PACU) postoperatively where she recovered well. She was observed overnight for pain control. On postoperative day 1, the nephrostomy tube was clamped and there was confirmed urinary drainage in the foley. The nephrostomy tube and foley catheter were removed. She was instructed on wound care and informed to follow-up for her postoperative visit. Follow-up renal bladder ultrasound (RBUS) confirmed that she was stone free. Patient Consent Statement: Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure No competing financial interests exist. Runtime of video: 4 mins 51 secs

Simultaneous laparoscopic surgery for ureteropelvic junction obstruction and retrograde intrarenal surgery for nephrolithiasis

Objective: To determine the surgical possibilities of the one-stage laparoscopic repair in the obstructed ureteropelvic junction (UPJ) complicated with nephrolithiasis in combination with the retrograde intrarenal surgery.Case report: The patient A., a 36-year-old male complaining about dragging pains in the right lumbar region was admitted to Urology Unit No. 1 of Krasnodar Regional Clinical Hospital No. 2. The patient underwent ultrasound examination, CT, and dynamic renal scintigraphy. The findings were as follows: the enlargement of pelvicalyceal system in the right kidney (calyx up to 22 mm, pelvis up to 50 mm), 5 calyx concrements and 2 pelvic concrements 6 to 8 mm in size, obstruction at the level of the right UPJ up to 10 mm in length, III grade hydronephrosis on the right according to Lopatkin classification.Conclusions: The combination of laparoscopic surgery and retrograde intrarenal surgery with the flexible ureteroscope and holmium laser is an effective and safe method for the treatment of UPJ obstruction complicated with nephrolithiasis.