Use of the Escape™ Nitinol Stone Retrieval Basket Facilitates Fragmentation and Extraction of Ureteral and Renal Calculi: A Pilot Study

Kesler, Stuart; Pierre, Sean A.; Brison, Daniel; Preminger, Glenn M.; Munver, Ravi

doi:10.1089/end.2008.0070

Cited by 38 publications

(23 citation statements)

References 15 publications

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“…A stone free rate of 100% was reported for patients with ureteric calculi, however location within the ureter and retropulsion of stone fragments was not specified. 8 The Stone Cone™ and PercSys Accordion® demonstrate greater clinical success for stones located in dilated proximal ureters than other devices currently available. The Stone Cone™ was first described in 2001 and has subsequently become one of the most studied anti-retropulsion devices.…”

Section: Kroczak Et Al Dual Usage Of a Stone Basket Discussionmentioning

confidence: 99%

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

Kroczak

Ghiculete

Sowerby

et al. 2018

CUAJ

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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.

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Section: Kroczak Et Al Dual Usage Of a Stone Basket Discussionmentioning

confidence: 99%

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

Kroczak

Ghiculete

Sowerby

et al. 2018

CUAJ

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“…For laser lithotripsy, combining the laser operation with grasping and stabilization of the stone in a basket has been performed. 26,27 For conventional holmium laser lithotripsy procedures, the fibers typically have core and overall diameters greater than 200 and 400 μm, respectively. Stone baskets are highly flexible, but when combined with a large-core-diameter laser fiber, endoscope flexibility and irrigation through the working channel is reduced.…”

Section: Hollow-tip Fiber Integration With Stone Basketmentioning

confidence: 99%

Hollow steel tips for reducing distal fiber burn-back during thulium fiber laser lithotripsy

et al. 2013

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Abstract. The use of thulium fiber laser (TFL) as a potential alternative laser lithotripter to the clinical holmium:YAG laser is being studied. The TFL's Gaussian spatial beam profile provides efficient coupling of higher laser power into smaller core fibers without proximal fiber tip degradation. Smaller fiber diameters are more desirable, because they free up space in the single working channel of the ureteroscope for increased saline irrigation rates and allow maximum ureteroscope deflection. However, distal fiber tip degradation and "burn-back" increase as fiber diameter decreases due to both excessive temperatures and mechanical stress experienced during stone ablation. To eliminate fiber tip burn-back, the distal tip of a 150-μm core silica fiber was glued inside 1-cm-long steel tubing with fiber tip recessed 100, 250, 500, 1000, or 2000 μm inside the steel tubing to create the hollow-tip fiber. TFL pulse energy of 34 mJ with 500-μs pulse duration and 150-Hz pulse rate was delivered through the hollow-tip fibers in contact with human calcium oxalate monohydrate urinary stones during ex vivo studies. Significant fiber tip burn-back and degradation was observed for bare 150-μm core-diameter fibers. However, hollow steel tip fibers experienced minimal fiber burn-back without compromising stone ablation rates. A simple, robust, compact, and inexpensive hollow fiber tip design was characterized for minimizing distal fiber burn-back during the TFL lithotripsy. Although an increase in stone retropulsion was observed, potential integration of the hollow fiber tip into a stone basket may provide rapid stone vaporization, while minimizing retropulsion. © The Authors.Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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“…shockwave lithotripsy (SWL), flexible ureterorenoscopy (fURS)) with affiliated morbidities and health-care costs have been reported [2, 7, 8]. Novel stone retrieval devices have been introduced to address the problem of accidental stone migration: Stone baskets [9, 10], suction devices [11], balloon catheters [12, 13] guidewire [14–16] and gel-based devices [17, 18] significantly reduced the incidence of stone retropulsion. On the contrary, these devices are associated with additional costs and some of them with a higher risk for ureteral injuries [2].…”

Section: Introductionmentioning

confidence: 99%

The “Guidewire-Coil”-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy

et al. 2017

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BackgroundStone retropulsion represents a challenge for intracorporeal lithotripsy of ureteral calculi. The consequences are an increased duration and cost of surgery as well as decreased stone-free rates. The use of additional tools to prevent proximal stone migration entails further costs and risks for ureteral injuries. We present the simple technique of using a coil of the routinely used guidewire to prevent stone retropulsion.MethodsWe retrospectively evaluated all patients with mid-to-proximal ureteral stones in 2014, which were treated by ureteroscopic lithotripsy (Ho: YAG and/or pneumatic lithotripsy). The preoperative stone burden was routinely assessed using low dose CT scan (if available) and/or intravenous pyelogram.ResultsThe study population consisted of 55 patients with 61 mid-to-proximal calculi. Twentyseven patients underwent semirigid ureterorenoscopy using the “Guidewire-Coil-Technique”, the second group (n = 28) served as control group using the guidewire as usual. There has been a statistically significant reduction of accidental stone retropulsion (2/27 vs. 8/28, p < 0.05) as well as a decreased use of auxiliary procedures (p < 0.05) compared to the control group. No difference was observed in operative time. One ureteral injury in the control group required a prolonged ureteral stenting.ConclusionThe “Guidewire-Coil-Technique” is a simple and safe procedure that may help to prevent proximal calculus migration and therefore may increase stone-free rates without causing additional costs.

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Use of the Escape™ Nitinol Stone Retrieval Basket Facilitates Fragmentation and Extraction of Ureteral and Renal Calculi: A Pilot Study

Abstract: The Escape basket appears to be safe and effective in preventing stone migration and facilitating ureteroscopic laser lithotripsy and stone extraction.

Cited by 38 publications

References 15 publications

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

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

Hollow steel tips for reducing distal fiber burn-back during thulium fiber laser lithotripsy

The “Guidewire-Coil”-Technique to prevent retrograde stone migration of ureteric calculi during intracorporeal lithothripsy

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