What procedure is recommended for two 7mm calculi in the lower pole of the renal pelvis if ECSL has failed?

When dealing with two 7mm calculi located in the lower pole of the renal pelvis after failed extracorporeal shock wave lithotripsy (ECSL), flexible ureterorenoscopy with Holmium laser is the most appropriate procedure.

This method is effective for treating kidney stones, particularly when the stones are relatively small and located in challenging anatomical areas such as the lower pole. Flexible ureterorenoscopy allows direct visualization and access to the stones, facilitating their fragmentation and removal. The use of a Holmium laser during this procedure is particularly beneficial as it efficiently breaks down the stones into smaller fragments that can either be extracted or passed naturally.

In contrast, open surgery may not be ideal for such a scenario due to its invasiveness and longer recovery times, especially when less invasive options with effective outcomes are available. Extracorporeal shock wave lithotripsy, which has already been attempted and failed in this case, is not an appropriate choice, as its prior failure suggests it might not effectively address the current stone situation. Observation is also not recommended for symptomatic calculi, as treatment is necessary to alleviate discomfort and prevent potential complications such as urinary obstruction or infection.

Therefore, flexible ureterorenoscopy with Holmium laser is