<section id="sec1" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><p id="p0010" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Giant&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureter-stone" title="Learn more about ureteric calculi from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureteric calculi</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;are very extremely rare and typically diagnosed in stones greater than 5 cm in length or 50 g in weight. They may occur as a consequence of tuberculosis,&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureterocele" title="Learn more about ureteroceles from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureteroceles</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">, an&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ectopic-ureter" title="Learn more about ectopic ureter from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ectopic ureter</span></a><span style="font-family: Helvetica; font-size: 14px;">, a benign&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureter-polyp" title="Learn more about ureteral polyp from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureteral polyp</span></a><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">, or in the absence of any&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/clinical-deformity" title="Learn more about anatomical abnormalities from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">anatomical abnormalities</span></a><span style="font-family: Helvetica; font-size: 14px;">.</span></span></span></span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;Traditional approaches to treating giant ureteral stones are based on the function of the affected kidney and may necessitate either active stone removal or a simple&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/nephroureterectomy" title="Learn more about nephroureterectomy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">nephroureterectomy</span></a><span style="font-family: Helvetica; font-size: 14px;">.</span></span></p><p id="p0015" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">As a consequence of breakthroughs in urologic interventional techniques and technologies, the ways to eradicate urolithiasis have increased. Miniaturized endoscopic combined intrarenal surgery (mini-ECIRS) is a novel therapeutic option that has become increasingly acceptable for the removal of large or complex&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/kidney-stone" title="Learn more about nephrolithiasis from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">nephrolithiasis</span></a><span style="font-family: Helvetica; font-size: 14px;">. To the best of our knowledge, this is the first clinical case reporting mini-ECIRS in a patient with a giant ureteric calculus.</span></p></section><section id="sec2" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><h2 id="sectitle0025" class="u-h3 u-margin-l-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;<b>Case report:</b></span></h2><div style="margin: 0px; padding: 0px;"><p id="p0020" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">A 58-year-old male was referred to our department with a large&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureter-stone" title="Learn more about ureteral stone from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureteral stone</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;that was detected during a routine medical examination. He was in excellent mental and physical health.&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/urinalysis" title="Learn more about Urinalysis from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">Urinalysis</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;showed modest&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/pyuria" title="Learn more about pyuria from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">pyuria</span></a><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;but negative&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/urine-culture" title="Learn more about urine cultures from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">urine cultures</span></a><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. The creatinine level in the blood was 1.1 mg/dL. A&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/computer-assisted-tomography" title="Learn more about computed tomography scan from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">computed tomography scan</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;revealed a calculus that was 11&nbsp;×&nbsp;12&nbsp;×&nbsp;67 mm</span></span></span></span><span style="margin: 0px; padding: 0px; font-size: 14px; line-height: 0; position: relative; vertical-align: baseline; top: -0.5em; font-family: Helvetica;">3</span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;in size with a density of 680 Hounsfield units at the right proximal&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureter" title="Learn more about ureter from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureter</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;as shown in9fig 1)</span></span><span style="font-family: Helvetica; font-size: 14px;">. Excretion was mildly decreased in the right kidney, but normal excretion was observed on the left side. After all, discussing the various treatment options with the patient, we concluded together that mini-ECIRS would be preferred.</span></p><figure class="figure text-xs" id="fig1" style="margin-bottom: 20px; padding: 8px 0px 0px; font-size: 0.7rem; line-height: 1.57; border-top: 1px solid rgb(185, 185, 185); border-bottom: 1px solid rgb(185, 185, 185);"><span style="margin: 0px; padding: 0px;"><img src="https://ars.els-cdn.com/content/image/1-s2.0-S2214442022002820-gr1.jpg" height="299" alt="Fig. 1" aria-describedby="cap0010" style="margin: 0px 0px 10px; padding: 0px; border-style: none; width: auto; max-width: 100%; height: auto;"><ol class="links-for-figure" style="margin-right: 0px; margin-bottom: 20px; margin-left: 0px; padding: 0px; list-style: none;"><br><li style="margin: 0px; padding: 0px; display: inline-block; white-space: nowrap;"></li></ol></span><span class="captions" style="margin: 16px 24px; padding: 0px; line-height: 22px; font-size: 16px;"><span id="cap0010" style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;Here, it is showing us the giant calculus; B,&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/fluoroscopy" title="Learn more about fluoroscopy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">fluoroscopy</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;showing the ureteric calculus that was relocated upward using a flexible ureteroscope.</span></span></span></figure></div><p id="p0025" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Intravenous prophylactic antibiotics (cefuroxime) were administered during the induction period of&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/general-anaesthesia" title="Learn more about general anesthesia from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">general anesthesia</span></a><span style="font-family: Helvetica; font-size: 14px;">. The patient was placed in the Galdakao-modified supine Valdivia position, in which the right flank was raised, and the buttock and leg were set in an asymmetrical&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/lithotomy-position" title="Learn more about lithotomy position from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">lithotomy position</span></a><span style="font-family: Helvetica; font-size: 14px;">. Two operating instruments were used simultaneously by two urologists: one used a miniature nephroscope, while the other used a flexible ureteroscope (fURS).</span></p><div style="margin: 0px; padding: 0px;"><p id="p0030" style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">First, a&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/cystoscopy" title="Learn more about cystoscopy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">cystoscopy</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;was carried out to gain retrograde access, and a retrograde&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/pyelogram" title="Learn more about pyelogram from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">pyelogram</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;was performed to delineate the ureter and pelvicalyceal system. for, Two-hybrid guidewires (Sensor™, Boston Scientific, Natick, MA) were then inserted into the ureteric orifice to reach the renal pelvis. A digital fURS, LithoVue™ (Boston Scientific, Marlborough, MA), was introduced over one guidewire until it made contact with the giant calculus. The stone pushed retrogradely into the renal pelvis by advancing the fURS without difficulty</span></span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. The second urologist performed an ultrasound-guided percutaneous puncture using an 18 G metallic needlepoint to the lower pole of the kidney. Tract dilatation was achieved over the guidewire to establish a 15 F working channel under direct visualization via the fURS.&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/laser-lithotripsy" title="Learn more about Laser lithotripsy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">Laser lithotripsy</span></a><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;was performed using the fragmentation technique with a 120 W&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/holmium" title="Learn more about holmium from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">holmium</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;laser (Lumenis, San Jose, CA) and a 550 μm core laser fiber with an energy of 1.5 J and a rate of 30 Hz as shown in fig2</span></span></span><span style="font-family: Helvetica; font-size: 14px;">. Finally, all the pieces of stone were extracted with graspers through a 12 Fr nephroscope MIP-M system (Karl Storz, City, Germany) or by the Venturi effect. At the end of the procedure, a retrograde 6Fr double-J stent was placed. We obtained plain films of the abdomen to assess residual stones and confirm that the patient kept the double-J stent in the appropriate position (Fig 3)</span><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. The patient made an uneventful&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/postoperative-recovery" title="Learn more about postoperative recovery from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">postoperative recovery</span></a><span style="font-family: Helvetica; font-size: 14px;">. The stent was been removed cystoscopically at 6 weeks&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/afterdischarge" title="Learn more about after discharge from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">after discharge</span></a><span style="font-family: Helvetica; font-size: 14px;">.</span></span></p><figure class="figure text-xs" id="fig2" style="margin-bottom: 20px; padding: 8px 0px 0px; font-size: 0.7rem; line-height: 1.57; border-top: 1px solid rgb(185, 185, 185); border-bottom: 1px solid rgb(185, 185, 185);"><span style="margin: 0px; padding: 0px;"><img src="https://ars.els-cdn.com/content/image/1-s2.0-S2214442022002820-gr2.jpg" height="308" alt="Fig. 2" aria-describedby="cap0015" style="margin: 0px 0px 10px; padding: 0px; border-style: none; width: auto; max-width: 100%; height: auto;"><ol class="links-for-figure" style="margin-right: 0px; margin-bottom: 20px; margin-left: 0px; padding: 0px; list-style: none;"><li style="margin: 0px; padding: 0px; display: inline-block; white-space: nowrap;"></li></ol></span><span class="captions" style="margin: 16px 24px; padding: 0px; line-height: 22px; font-size: 16px;"><span id="cap0015" style="margin: 0px; padding: 0px;"><p id="fspara0015" style="margin-bottom: 16px; padding: 0px;"><span class="label" style="margin: 0px; padding: 0px; font-family: Helvetica; font-size: 14px;">Fig. 2</span><span style="font-family: Helvetica; font-size: 14px;">.&nbsp;Miniature nephoscope view of the giant calculus.</span></p></span></span></figure><figure class="figure text-xs" id="fig3" style="margin-bottom: 20px; padding: 8px 0px 0px; font-size: 0.7rem; line-height: 1.57; border-top: 0px; border-bottom: 1px solid rgb(185, 185, 185);"><span style="margin: 0px; padding: 0px;"><img src="https://ars.els-cdn.com/content/image/1-s2.0-S2214442022002820-gr3.jpg" height="464" alt="Fig. 3" aria-describedby="cap0020" style="margin: 0px 0px 10px; padding: 0px; border-style: none; width: auto; max-width: 100%; height: auto;"><ol class="links-for-figure" style="margin-right: 0px; margin-bottom: 20px; margin-left: 0px; padding: 0px; list-style: none;"><li style="margin: 0px; padding: 0px; display: inline-block; white-space: nowrap;"></li></ol></span><span class="captions" style="margin: 16px 24px; padding: 0px; line-height: 22px; font-size: 16px;"><span id="cap0020" style="margin: 0px; padding: 0px;"><p id="fspara0020" style="margin-bottom: 16px; padding: 0px;"><span class="label" style="margin: 0px; padding: 0px; font-family: Helvetica; font-size: 14px;">Fig. 3</span><span style="font-family: Helvetica; font-size: 14px;">.&nbsp;Post-operative abdominal plain radiography showing no evidence of residual calculi.</span></p></span></span></figure></div></section><section id="sec3" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><h2 id="sectitle0030" class="u-h3 u-margin-l-top u-margin-xs-bottom" style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;<b>Discussion:</b></span></h2><ul><li style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Ureteral calculi are stones made up of crystals in the renal collecting system that then migrate down the&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/ureter" title="Learn more about ureter from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">ureter</span></a><span style="font-family: Helvetica; font-size: 14px;">. </span></span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">They are more likely to become stuck in locations where the ureter is at its narrowest. In general, stones that are less than 4 mm in size are small enough to pass spontaneously in most patients.</span></span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;"> However, for stones greater than 7 mm in width, the probability of spontaneous passage is significantly lower.</span></span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;The best solution for a giant ureteric calculus is controversial. </span></span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">The open approach is the preferred choice for most surgeons; however, extracorporeal shock wave&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/lithotripsy" title="Learn more about lithotripsy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">lithotripsy</span></a><span style="margin: 0px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">, transurethral lithotripsy,&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/percutaneous-nephrolithotomy" title="Learn more about percutaneous nephrolithotomy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">percutaneous nephrolithotomy</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;(PCNL), and&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/laparoscopic-surgery" title="Learn more about laparoscopic surgery from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">laparoscopic surgery</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;have also been reported. Notwithstanding, there are no reports of mini-ECIRS for the management of this interesting calculus.</span></span></span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">ECIRS was the first described by Scoffone in 2008 to standardize the synergist procedure between retrograde intrarenal surgery and PCNL for large and/or complex urolithiasis to improve efficiency and safety.&nbsp;</span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">This combination technique facilitates lithotripsy while keeping the patient in a single position and accessing the collecting system only once. </span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">The distinguishing benefits of performing the double scopes demonstrated in our case were the relocation of the giant stone upward into the renal pelvis, ureteroscopy-assisted puncture, and the retrieval of any fragments of broken stone that scattered in the different calyx that evades multiple tracts and may cause related bleeding. Moreover, we employed the small access sheath (15 Fr) of a miniature nephroscope, which has significant advantages in terms of reducing the likelihood of kidney injury, bleeding, and the requirement for transfusion.&nbsp;</span></li><li style="margin-bottom: 16px; padding: 0px;"><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">The nephrostomy-free or “tubeless” option was considered appropriate in this case as it helps reduce&nbsp;</span><a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/postoperative-pain" title="Learn more about postoperative pain from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">postoperative pain</span></a><span style="font-family: Helvetica; font-size: 14px;">, analgesia requirements, and hospital stay. We confirm the excellent results of the mini-ECIRS procedure by the absence of any pieces of residual stone in plain films of the abdomen administered post-surgery.</span></span></li></ul></section><section id="sec4" style="margin: 0px 0px 8px; padding: 0px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px;"><ul><li style="margin-right: 0px; margin-left: 0px; padding: 0px; color: rgb(80, 80, 80); margin-top: 32px !important; margin-bottom: 8px !important; font-size: 1.2rem !important; line-height: 1.333 !important;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;<b>Conclusion</b></span></li></ul><p id="p0045" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Hence, We successfully treated a giant ureteric calculus using mini-ECIRS. This novel technique is safe and feasible, with low morbidity.</span></p></section>