A Hybrid Technique For Challenging Urolithiasis, A Case Report.

Urolithiasis treatment has evolved over the years with so many advances especially in the developed world. These modern techniques include endoscopic, percutaneous, laparoscopy and even robotic approaches. At present, open stone surgery may sound obsolete in developed world yet still relevant in some parts of the developing world. A combination of open and modern methods to treat complex renal or ureteric stones in a single patient sounds strange. However, when faced with complex stone burden in a frail patient and limited resource setting, a combination of both open and endoscopic technique maybe the most reasonable approach. We present a case of a 72-year-old female patient who presented with a 4.5cm impacted ureteric stone and multiple renal calyceal stones. None of the modern stone surgery techniques were inadequate to clear the stones. Open surgery alone was also going to be too much and inappropriate. The stones were successfully treated by combining open surgery (ureterolithotomy) and retrograde endoscopic surgery in a single sitting. This encourages all urologist to be open minded regarding stone treatment options.