{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T08:18:31Z","timestamp":1775204311951,"version":"3.50.1"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Fujian Provincial Science and Technology Innovation Joint Funds","award":["2024Y9451"],"award-info":[{"award-number":["2024Y9451"]}]},{"name":"Fujian Provincial Health Commission Science and Technology Innovation Project","award":["2024CXA051"],"award-info":[{"award-number":["2024CXA051"]}]},{"name":"the 910th Hospital Intramural Research Project","award":["910YK202408"],"award-info":[{"award-number":["910YK202408"]}]},{"DOI":"10.13039\/501100003392","name":"natural science foundation of fujian province","doi-asserted-by":"publisher","award":["2024J011256"],"award-info":[{"award-number":["2024J011256"]}],"id":[{"id":"10.13039\/501100003392","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Urology"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The lower calyx is the most common site for kidney stones. While minimally invasive, flexible ureteroscopic lithotripsy often yields suboptimal stone-free rates (SFR) for lower calyx stones due to anatomical constraints and limited endoscope deflection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of a novel technique that combines Sotn ureteroscopy (Sotn-URS) with flexible ureteroscopy (fURS), involving stone displacement before lithotripsy, for managing lower calyx stones \u2a7d20\u2009mm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A retrospective comparative study complemented by in vitro simulation experiments.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      An in vitro model assessed the impact of a 200\u2009\u00b5m laser fiber, a 365\u2009\u00b5m fiber, a 1.7 Fr stone retrieval basket, and a flexible ureteral sheath on the deflection of a single-use fURS. In all, 240 patients with lower calyx stones (\u2a7d20\u2009mm) were allocated to either the experimental group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009114) or the control group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u2009126). The experimental group underwent combined Sotn-URS and fURS with basket-assisted stone displacement to the kidney pelvis or upper ureter before laser lithotripsy. The control group underwent conventional in situ lithotripsy using fURS alone. Outcomes, including operative time, SFR (immediate and at 4\u2009weeks), surgeon comfort (Borg scale), first-pass sheath placement success, and complications, were compared.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The maximum deflection angle of the fURS alone was 295.7\u00b0. Insertion of a 365\u2009\u00b5m fiber significantly reduced this angle to 270.1\u00b0, while a 200\u2009\u00b5m fiber or basket had minimal impact (293.3\u00b0 and 293.4\u00b0, respectively). Compared with control group, the experimental group demonstrated significantly higher immediate SFR (85.1% vs 73.0%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and 4-week SFR (91.2% vs 81.7%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05), along with shorter total operative time (51.7 vs 70.4\u2009min,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) and fURS intrarenal time (22.2 vs 52.2\u2009min,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Surgeon comfort was better (Borg score 0.63 vs 2.9,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05), and the rate of ureteral mucosal injury was lower (3.5% vs 11.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The stone displacement technique utilizing combined Sotn-URS and fURS is an efficient and safe surgical approach for lower calyx stones \u2a7d20\u2009mm. It uses the stable access and efficient lithotripsy of rigid Sotn-URS and the flexibility of fURS for stone displacement, resulting in improved stone clearance rates, reduced operative time, and lower ureteral injury risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17562872261423750","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:59:29Z","timestamp":1774954769000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stone displacement with combined Sotn ureteroscopy and flexible ureteroscopy for lower calyx stones \u2a7d20\u2009mm: a retrospective comparative study"],"prefix":"10.1177","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6991-1404","authenticated-orcid":false,"given":"Jianping","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Urology, Affiliated Haixia Hospital of Huaqiao University (The 910th Hospital of Joint Logistics Support Force), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5248-0104","authenticated-orcid":false,"given":"Mengqing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Haixia Hospital of Huaqiao University (The 910th Hospital of Joint Logistics Support Force), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shaomei","family":"Lin","sequence":"additional","affiliation":[{"name":"Key Laboratory of Marine Natural Medicine and Biopharmaceuticals, Quanzhou Medical College, Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxia","family":"Wu","sequence":"additional","affiliation":[{"name":"Prenatal Diagnosis Center, Quanzhou Maternal and Child Health Hospital (Quanzhou Children\u2019s Hospital), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinhua","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Laboratory, Joint Logistics Support Force 910th Hospital, Quanzhou, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiying","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Haixia Hospital of Huaqiao University (The 910th Hospital of Joint Logistics Support Force), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Haixia Hospital of Huaqiao University (The 910th Hospital of Joint Logistics Support Force), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zihuang","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Urology, Affiliated Haixia Hospital of Huaqiao University (The 910th Hospital of Joint Logistics Support Force), Quanzhou, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rongkai","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Urology, Joint Logistics Support Force 910th Hospital, No. 180 Huayuan Road, Fengze District, Quanzhou 362000, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4350-4332","authenticated-orcid":false,"given":"Lingfeng","family":"Zhu","sequence":"additional","affiliation":[{"name":"Minimally Invasive Urology and Translational Medicine Research Center, Fuzhou First Hospital Affiliated with Fujian Medical University, No. 190 Dadao Road, Taijiang District, Fuzhou 350009, Fujian, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11030424"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/nu16142198"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1590\/s1677-5538.ibju.2020.1023"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13041114"},{"key":"e_1_3_4_6_2","unstructured":"American Urological Association. 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