Endoscopic Management of a Large Calculus in a Transplant Kidney

advancing an access sheath into the transplant ureter, a Storz Flex-X2 fiber optic flexible ureteroscope was used to access the collecting system over one of the wires. A 365-micron holmium laser fiber was used to fragment the stone into small pieces. The largest stone fragments were extracted using a basket, however due to the lack of an access sheath to assist in passing the ureteroscope in and out of the renal collecting system, the decision was made to insert a ureteral stent with plan for a second stage ureteroscopy and lithotripsy.