To compare different treatment approaches in patients with failed ureteral access sheath placement during first flexible ureterorenoscopy (f-URS) session.

Patients with kidney stones measuring 1–2 cm, presented to our urology clinic between September 2020 and September 2021, were included in the study for evaluation. The study was designed prospectively (Clinical-Trials number NCT05911945). Patients were randomized into two groups, in case of a failed ureteral access sheath placement during the first f-URS session. In group 1, JJ stent was placed for dilation and second session of f-URS was planned. In group 2, mini percutaneous nephrolithotomy (mPNL) was performed in the same session.

Twenty-four patients were included in each group. Pre-operative demographic data and stone characteristics of the patients in each group were comparable. Operation time, fluoroscopy time, and hospital stay were significantly higher in the mini-PNL group. When SF-36 values were compared, physical function, pain, role limitation, and general health value scores were improved in both groups after treatment. The improvement in physical function and pain parameters was statistically significant in the mPNL group. In patients with failed ureteral access sheath placement, placing a JJ stent for dilation and postponing f-URS for 4–6 weeks provides the advantages of low hospitalization time for each admission, shorter fluoroscopy and operation time.

Performing mPNL in the same session, results in better improvements in SF-36 parameters such as pain and physical function compared to f-URS. The success and complication rates of the two procedures were comparable.