ArticleBMC urology2026
Flexible ureteroscopy across calyceal locations: impact of ureteroscope caliber and lower-pole anatomy on stone-free outcomes : Sheathless RIRS: Calyx Anatomy and Scope Size.
Article in BMC urology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study compared the clinical performance of 7.5 F and 9 F digital flexible ureteroscopes in sheathless retrograde intrarenal surgery (RIRS), with a particular focus on how ureteroscope caliber interacts with lower-pole anatomy to influence stone-free outcomes.
methodsThis retrospective study included patients who underwent sheathless RIRS for single renal stones measuring 10–20 mm between October 2023 and August 2025 using either a 7.5–9 F digital flexible ureteroscope. All procedures were performed by three experienced surgeons under a standardized protocol. Stone-free status (SFR) was defined as residual fragments ≤ 4 mm on 1-month non-contrast CT. Perioperative parameters and complications were compared between groups. A prespecified lower-pole subgroup analysis examined the relationship between IPA and clearance using logistic regression and ROC analysis.
resultsSeventy patients were analyzed (7.5 F = 37; 9 F = 33). Overall SFRs were 78.4% and 69.7% for the 7.5 F and 9 F groups, respectively (p = 0.42). Complication rates were low and comparable. In the lower-pole subgroup, the 7.5 F scope achieved a significantly higher SFR (64.7% vs. 23.1%, p = 0.03). Multivariable analysis identified ureteroscope caliber (adjusted OR = 5.76, p = 0.036) and IPA (adjusted OR = 0.92 per degree, p = 0.017) as independent predictors of lower-pole clearance, with moderate discriminative ability for IPA (AUC = 0.682).
conclusionIn sheathless RIRS, smaller-caliber ureteroscopes were associated with higher stone-free rates for lower-pole stones, while overall outcomes were comparable between groups. Lower-pole anatomy was significantly associated with stone-free outcomes.
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