Patient Positioning for Treatment of Proximal Ureteral Stones

Ureteroscopic management of proximal ureteral stones presents technical challenges including stone retropulsion, prolonged operative time, and conversion to intrarenal treatment. Reverse Trendelenburg positioning has been shown to reduce proximal stone migration and operative time in ureteral stones, while the T-tilt position improves intrarenal stone clearance. The optimal strategy for proximal ureteral stones (treating stones in situ using reverse Trendelenburg versus pushing stones into the kidney followed by intrarenal treatment in T-tilt) remains unknown. This randomized controlled trial compares these two strategies, with primary focus on operative time as a measure of procedural efficiency. A total of 54 patients (27 per arm) will be enrolled at Mount Sinai West.

Inclusion criteria: * Adults aged 18 years and older. * Diagnosed with kidney stones and scheduled for fURS. * Stone burden \> 1 cm and/or multiple stones will be eligible. * Able and willing to provide informed consent. Exclusion criteria: * Pregnant persons as determined by pre-operative urine pregnancy test (standard of care at the institution) * Untreated UTI * Patients with urinary anomalies (e.g., urinary diversion, ureteral reconstruction, horseshoe kidney) * Single stone \< 1 cm