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Patients were randomized according to the size of ureteroscope into two groups: group 1 where a 4.5\/6 Fr semi-rigid ureteroscope was used, and group 2 where a 6\/7.5 Fr semi-rigid ureteroscope was used. Patient\u2019s demographic, stone characteristics, intraoperative and postoperative outcomes including stone-free rate (SFR) and complications were compared.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Preoperative characteristics in terms of age, sex, BMI, and stone location, side, size, and HU were comparable between both groups (<jats:italic>p<\/jats:italic> values\u2009&gt;\u20090.05). The overall SFR was significantly higher in group 1 (0.004). Balloon dilatation was not required in all patients of group-1 compared with 33% of group-2 (<jats:italic>p\u2009=\u2009<\/jats:italic>0.0001). The JJ stent was required in 10% of group-1 compared with 30% of group-2 (<jats:italic>p\u2009=\u2009<\/jats:italic>0.0004). Failure to reach the stone due to tight ureter occurred in 8% of group 2 (<jats:italic>p\u2009=\u2009<\/jats:italic>0.003), respectively. Traxer\u2019s grade 1 ureteral injury occurred in 2% of group-1 versus 14% of group-2 (<jats:italic>p\u2009=\u2009<\/jats:italic>0.001). Consequently, hematuria was significantly lower in group-1 (1% vs. 8%; <jats:italic>p\u2009=\u2009<\/jats:italic>0.01), respectively. The hospital stay\u2009&lt;\u20099\u00a0h was significantly higher in group 1 (<jats:italic>p\u2009=\u2009<\/jats:italic>0.0001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The 4.5\/6 Fr semi-rigid Ureteroscope was associated with significantly higher SFR and shorter hospital stay, with lower ureteral injury, fewer double-J stenting, and without the need for intraoperative balloon dilatation for the ureter.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-022-04173-2","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T10:04:47Z","timestamp":1665223487000},"page":"3075-3081","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Randomized comparison of 4.5\/6 Fr versus 6\/7.5 Fr ureteroscopes for laser lithotripsy of lower\/middle ureteral calculi: towards optimization of efficacy and safety of semirigid ureteroscopy"],"prefix":"10.1007","volume":"40","author":[{"given":"Mohamed","family":"Omar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Dorrah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Khalifa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eid","family":"El Sherif","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Sayedahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yahya","family":"Ghazwani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5498-2076","authenticated-orcid":false,"given":"Yasser A.","family":"Noureldin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,8]]},"reference":[{"key":"4173_CR1","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/0090-4295(93)90356-F","volume":"42","author":"AD Jenkins","year":"1993","unstructured":"Jenkins AD (1993) ESWL: distal ureteral stone management\u20141993. 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