The authors share their experience of treating large proximal ureteral stones using semirigid ureteroscopes and a pneumatic lithotripter. At first glance, it would appear that overall they achieved remarkably outstanding stone-free rates. However, there was a 20% rate of failed initial ureteroscopy (7% in women, 35% in men), which is not surprising given the fact that the authors were using large-diameter (8-13.5 F) instruments. The higher failure rate in men is not surprising and reflects the fact that the male lower urinary tract anatomy at times is just not suited for ureteroscopy of the proximal ureter. The mere fact that 80% of the time the proximal stone was accessed is a testament to the expertise of the authors in performing semirigid ureteroscopy. Semirigid Ureteroscopy in Management of Large Proximal Ureteral Calculi: Is There Still a Role in Developing Countries?UrologyVol. 77Issue 5PreviewTo evaluate the outcome and complications of the use of semirigid ureteroscopy (URS) together with intracorporeal pneumatic lithotripsy in the management of upper ureteral calculi >10 mm in diameter. Full-Text PDF ReplyUrologyVol. 77Issue 5PreviewWe share the same opinion as the editors that if flexible instruments and holmium laser lithotripsy were available, they would be the first choice in the management of large proximal ureteric stones. However, we all know how expensive the cost of such equipment is in developing countries, making them available only in extremely selected institutes. We offer semirigid ureteroscopy to patients, knowing that we would expect a failure rate, to spare them the other alternative, open surgery. As the editors' state, “… the higher failure rate in men is not surprising and reflects the fact that the male lower urinary tract anatomy at times is just not suited for ureteroscopy of the proximal ureter.” Full-Text PDF