Successful Treatment with a 6.3-Fr Disposable Digital Flexible Ureteroscope and Holmium Laser Lithotripsy in a 50-Year-Old Man with Large Bilateral Ureteral Stones and Hydronephrosis

BACKGROUND This report describes a 50-year-old man with large bilateral ureteral stones and hydronephrosis. Bilateral impacted large ureteral stones present significant clinical challenges and can lead to serious complications, such as hydronephrosis, urinary tract infections, and renal function impairment. Due to their size and location, treatment often requires advanced techniques and specialized equipment to achieve optimal outcomes while minimizing complications. In the present case, use of the smallest 6.3-Fr flexible ureteroscopy with holmium laser lithotripsy effectively managed the condition, demonstrating its utility in treating complex ureteral stones. CASE REPORT A 50-year-old man received a diagnosis of bilateral impacted ureteral stones. The right ureteral stone measured 22×10×10 mm, and the left stone was 11×10×8 mm, accompanied by hydronephrosis. After antibiotic therapy, flexible ureteroscopic lithotripsy was performed using a 6.3-Fr disposable digital flexible ureteroscope. Holmium laser fragmentation was followed by stone fragment retrieval using a vacuum-assisted ureteral access sheath. Postoperative computed tomography confirmed complete stone clearance and significant improvement in hydronephrosis. The patient had an uneventful recovery without significant complications. CONCLUSIONS The 6.3-Fr disposable flexible ureteroscope is highly effective for large impacted ureteral stones. Its small diameter minimizes ureteral trauma, enhances irrigation, and provides superior visualization. The vacuum-assisted ureteral access sheath facilitates efficient stone retrieval, reducing operative time and complications. This case highlights the potential advantages of the 6.3-Fr ureteroscope in treating complex urolithiasis, especially in patients with challenging anatomical conditions. Further studies and clinical trials are needed to validate its broader application and long-term outcomes.