PRMARY RIRS:LOWER CALYEAL CALCULUS

 A 29 year old gentleman came with pain in right flank since 3 months.On evaluation was found to have right lower calyceal calculus around 9 mm.He was taken up for Retrograde Intrarenal Surgery. The stone was cleared with holimum laser 200 microns .
The ureter especially the lower ureter was tight and had to dilated with ballon dilatation under fluoroscopic guidance with contrast.We routinely do a check ureteroscopy with 6-7.5 rigid ureteroscope to see the ureteric anatomy before introducing the sheath.
We tried to introduce the sheath in this case but didnot allow beyond a few cms in ureter so it was kept there and through the sheath the flexible ureteroscope was introduced.The complete clearance was achieved and a 5 Fr DJ stent was kept ..