Ureteroscopy-assisted retrograde nephrostomy (UARN) without ureteral access sheath (UAS)

INTRODUCTION: We previously described ureteroscopy assisted retrograde nephrostomy (UARN). In UARN, it is possible to continuously visualize the dilation of the ureter from puncture to insertion of the nephroaccess sheath with minimal complication. But in the course of making nephrostomy, UARN requires ureteral access sheath (UAS). UAS has a potential risk of ureteral stricture. Herein, we report the first case of UARN without the use of UAS. PRESENTATION OF CASE: A 53-year-old female was referred to our hospital for treatment of her right renal stone. Because her stone burden was 27 mm, we planned to perform percutaneous nephrolithotomy (PCNL) using UARN without UAS. DISCUSSION: UAS facilitates a decrease in the intrarenal pressure due to irrigation, and it makes controlling the URS easier. However, in terms of the risk of ureteral stricture, unnecessary insertion of a UAS should be avoided. CONCLUSION: We describe the first case of a renal stone successfully treated by PCNL using the UARN method without the use of a UAS.