Purpose To evaluate the simultaneous antegrade and retrograde endourological approach in the Galdakao-modified supine Valdivia position (GMSVP) for the management of missed stent with complex renal stones. Methods Over 5 years, patients presented to our clinic or referred to our hospital with missed DJ stent and complex renal stones were included prospectively in our study. Inclusion criteria were patients with neglected DJ stents (more than 6 months) complicated with complex stone burden, in addition to stents that was Fragmented and required renal access for removal. Stent and stone removal were performed using a simultaneous antegrade and retrograde renal approach in the GMSVP. The success rate and any perioperative complications were recorded. Results 45 patients were available for evaluation. The average stone size was 3.9 +/- 0.8 cm. Renal stones, ureteric stones, and bladder stones were present in 39, 24, and 10 patients, respectively .Two patients had fragmented DJs. Semirigid ureteroscopy with PCNL was used in 19 (42.2%) cases, ECIRS in 17 (37.7%) cases, Cystolitholapaxy and PCNL in 10 (22.2%) cases. Mean operative time was 70.8 +/- 10.2 min, mean hospital stay was 2.3 +/- 0.8 days. The stone-free rate was 93.3% after one procedure, two patients needed an auxiliary SWL for residual stones, postoperative complications were seen in 24.4% of patients. Conclusion Simultaneous antegrade and retrograde renal approach in the GMSVP is safe and effective in the management of missed DJ stents with a complex stone burden.
