TIPS & TRICKS - Railway Technique to Access the Stone

URS for 8 mm left ureteral stone. The ureter was cannulated with a stiff guidewire (straight tip). The ureteral orifice seemed very narrow. Therefore, it was decided that a second working guidewire would be used to backload the semirigid ureteroscope.

Once the second working guidewire entered the ureter, it became large enough to allow the passage of the ureteroscope. It can be advanced in the slit created between the two guidewires. After a few centimeters, the stone is visible. The working guidewire can be removed and the stone can be extracted/fragmented depending on its size.