Dual usage of a stone basket: Stone capture and retropulsion prevention

Abstract

Introduction: Stone migration during ureteroscopy (URS) for proximal ureteric calculi is a constant challenge. Several retropulsion prevention devices have been developed in order to optimize URS outcomes. Our technique involves capturing the stone within a four-wire Nitinol stone basket and then preforming laser lithotripsy to dust the stone while it is engaged in the basket. The dusted fragments wash out with the irrigation fluid and once small enough, the remaining stone is removed intact. Methods: A retrospective chart review was preformed of all proximal URS procedures performed with semi-rigid URS for a solitary calculus (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). We compared our new technique introduced in 2010 to URS control procedures that did not use retropulsion prevention techniques or devices. Results: One hundred and forty patients underwent URS for proximal ureteric calculi. Mean stone diameter was 9.3±3.4 mm, with similar impaction rate between both groups (44.1% vs. 43.1% control; p=n/s). The mean surgical procedure time was 53.3±17.9 minutes for the new technique and 65.2±29.2 minutes for the control group (p=0.005). Compared to the new technique, the control group had a higher rate of retropulsion (33.3% vs. 14.7%; p=0.01) and required flexible URS more often to exclude or remove residual fragments (24.1% vs. 59.1%; p=0.001). Using the new technique, stone-free rates were higher (79.1% vs. 69.4%; p=n/s) and there was a lower likelihood of leaving residual fragments both <3 mm and ≥3 mm (p=0.001). Conclusions: Our novel technique results in shorter operative times, lower retropulsion rates, and decreases postoperative residual stone fragments.

A modified basket catheter technique with semi-rigid ureterorenoscopy in the prevention of migration of proximal ureteral stones

“…In his study with a small group of patients, Kesler et al [9] determined the complete stone-free rate to be 100%, but he did not refer to stone localization or stone migration. In another study investigating the dual use of a basket catheter, Kroczak et al [10] reported stone migration in 10 patients (14.7%), which is similar to the rate determined in the current study (five patients; 11.4%). However, the requirement of switching to FURS was lower in our study (two patients; 5.5%) compared to the study by Kroczak et al [10] (19 patients; 24.1%).…”

“…In another study investigating the dual use of a basket catheter, Kroczak et al [10] reported stone migration in 10 patients (14.7%), which is similar to the rate determined in the current study (five patients; 11.4%). However, the requirement of switching to FURS was lower in our study (two patients; 5.5%) compared to the study by Kroczak et al [10] (19 patients; 24.1%). Lastly, our higher rate of JJ stent requirement in the control group may be due to the requirement of FURS in more patients in this group.…”

“…In the presented technique, the modified basket catheter was used to both prevent stone migration and retrieve residual stones after fragmentation. In the study of Kesler et al [9] concerning the Escape® basket (Boston Scientific Corp., Natick, MA, USA) and that of Kroczak et al [10] investigating a basket catheter, the basket and laser were both inside the ureterorenoscope. In contrast, in the current study, the ureterorenoscope and laser were used independently from the basket catheter.…”

“…In order to increase the success of the procedure and prevent stone migration, many mechanic devices (wire-balloon) and gels have been developed and provided successful results when placed in the proximal part of the stone. Stone baskets, such as LithoCatch ® , Parachute ® and Escape ® , as well as vacuum device Lithovac ® , balloon basket Parachute ® , and Stone Cone ® , PercSys Accordion ® and NTrap ® that form a barrier in the proximal of the stone are among mechanical tools designed to prevent stone migration [8][9][10][11][12][13][14][15][16]. In addition, BackStop ® gel is a temporary congestion-forming substance in the heat-sensitive proximal of the stone to prevent migration [17].…”

The Efficacy and Safety of Simultaneous Use of Wire Stone Basket and Pneumatic Lithotripter Probe in the Treatment of Ureteral Stones: Randomized Control Trial

“…Though if three wires were still intact, it has been useful in stone lasering, and he reported this method as a unique technique. In the present study, similar to Kroczak's study, the operation time was shorter, and success was higher and the need for a secondary procedure was reduced, and the only difference with the study of Kroczak is the use of pneumatic lithotripter instead of fiber lasers and with this probe, control might be harder with the heavy piston handle and the use of mechanical thrusts, but it's affordable and accessible in comparison to the laser [21]. In another study, wang, et al in China in 2011 investigated the effect of N-trap on proximal ureter stones treatment.…”