Editorial Comment to Usefulness of ureteroscopic lithotripsy in Izuo position for patients with difficulty opening legs.

Population aging represents a global issue, featuring significant implications for health care and medical decision making. Urolithiasis is a frequent disorder affecting all age groups. With improvements in medical care and life expectancy, stone disease may become more common in the geriatric population.1 The treatment of urinary stones through ureteroscopy (URS) in elderly patients was proved to be feasible and safe.2 However, urologists might occasionally have to deal with orthopedic conditions that make endourological maneuvers difficult to be performed. The article by Taguchi et al. presents an uncommon, but challenging scenario, involving eight patients unable to assume the classic lithotomy position, undergoing URS for stone treatment.3 All patients underwent stent insertion for ureteral stones and subsequent URS with flexible devices in the Izuo position, with the lower body in semilateral position toward the affected side. Good outcomes were achieved, without significant complications. Not surprisingly, difficulties were encountered in reaching the bladder with semirigid ureteroscope in male patients, while a flexible cystoscope was initially used to insert a guidewire into the ureter. Stent insertion and its regular substitution is a common adopted option in case of unsurpassed management difficulties. However, it is well known that chronically indwelling stent may not be risk-free, featuring a wide variety of complications and adverse effects.4 Innovation in surgery is always welcome, especially in order to overcome insurmountable difficulties. However, considering the mean age of the participants, patients should be carefully selected for the active treatment of urolithiasis, especially in case of stone migration back in the renal cavities during stent insertion, since these patients may not experience further stone-related acute events.5 Due to the technical difficulties of URS in the Izuo position, surveillance, or even watchful waiting, may be considered as the primary option in this cases. Nonetheless, the tips of this article may be useful for endourologists in selected cases. None declared.