Renal matrix calculi are rare, soft, and gelatinous kidney stones that present a challenge in endourology. Traditionally, percutaneous nephrolithotomy (PCNL) has been the preferred treatment due to its superior efficiency in fragmenting and removing these stones. However, with advancements in endoscopic instruments, the flexible and suction ureteral sheath has emerged as a potential alternative, allowing for improved fragment evacuation during retrograde intrarenal surgery (RIRS). This study presents two cases demonstrating the feasibility and limitations of this novel approach.

Two patients with renal matrix calculi underwent staged RIRS using a flexible ureteroscope and a flexible and suction ureteral sheath. The surgical approach was designed to maximize stone clearance while minimizing complications. Each procedure was assessed based on operative time, stone-free status, and perioperative safety.

Both patients underwent at least two RIRS sessions due to the challenging nature of matrix stones. The use of the flexible and suction ureteral sheath improved fragment evacuation, but complete clearance required multiple sessions. No major intraoperative or postoperative complications occurred, confirming the safety of this approach. However, compared to PCNL, the suction sheath’s effectiveness in handling matrix stones was suboptimal.

The flexible and suction ureteral sheath is a promising tool for managing renal matrix calculi through RIRS, offering a less invasive alternative to PCNL. However, its efficiency remains limited, often necessitating multiple procedures. Further research and technological advancements are needed to refine this technique and enhance its clinical efficacy.