The Cystoscope Sheath as a Platform for Performing Retrograde Intrarenal Surgery in a Transplanted Kidney with Complex Renal Anatomy

Endourology is a widely used means by which to manage urolithiasis. Patient anatomy can oftentimes limit what can be accomplished with current technology. This is a case of a patient with renal and ureteral stones within a transplant kidney. Her anatomy would not allow for a standard retrograde ureteroscopic approach. We describe a method by which to overcome this difficult scenario by using a rigid cystoscope as a platform by which a ureteroscope was passed to allow for stone removal. For this difficult case, we effectively used our instruments to achieve our goal of retrograde ureteroscopy in a transplant kidney with an unfavorably angulated ureter.