Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
Urology (Impact Factor: 2.13). 01/2001; DOI: 10.1016/S0090-4295(00)00821-9

ABSTRACT Objectives. Current ureteroscopic intracorporeal lithotripsy devices and stone retrieval technology allow for the treatment of calculi located throughout the intrarenal collecting system. Difficulty accessing lower pole calculi, especially when the holmium laser fiber is used, is often encountered. We retrospectively reviewed our experience with cases in which lower pole renal calculi were ureteroscopically managed by holmium laser fragmentation, either in situ or by first displacing the stone into a less dependent position with the aid of a nitinol stone retrieval device.Methods. Thirty-four patients (36 renal units) underwent ureteroscopic treatment of lower pole renal calculi between April 1998 and November 1999. Lower pole stones less than 20 mm were primarily treated by ureteroscopic means in patients who were obese, in patients who had a bleeding diathesis, in patients with stones resistant to shock wave lithotripsy, and in patients with complicated intrarenal anatomy, or as a salvage procedure after failed shock wave lithotripsy. Lower pole calculi were fragmented with a 200-μm holmium laser fiber by way of a 7.5F flexible ureteroscope. For those patients in whom the laser fiber reduced the ureteroscopic deflection, precluding re-entry into the lower pole calix, a 3.2F nitinol basket or a 2.6F nitinol grasper was used to displace the lower pole calculus into a more favorable position, allowing easier fragmentation.Results. In 26 renal units, routine in situ holmium laser fragmentation was successfully performed. In the remaining 10 renal units, a nitinol device was passed into the lower pole, through the ureteroscope, for stone displacement. Only a minimal loss of deflection was seen. Irrigation was significantly reduced by the 3.2F nitinol basket, but improved with the use of the 2.6F nitinol grasper. This factor did not impede stone retrieval in any of the patients. At 3 months, 85% of patients were stone free by intravenous urography or computed tomography.Conclusions. Ureteroscopic management of lower pole calculi is a reasonable alternative to shock wave lithotripsy or percutaneous nephrolithotomy in patients with low-volume stone disease. If the stone cannot be fragmented in situ, nitinol basket or grasper retrieval, through a fully deflected ureteroscope, allows one to reposition the stone into a less dependent position, thus facilitating stone fragmentation.

  • [Show abstract] [Hide abstract]
    ABSTRACT: PurposeCompare, in a retrospective study, the indications, the efficiency and the morbidity of the flexible ureteroscopy (URS) and the mini percutaneous nephrolithotomy (mini-perc) for the treatment of the renal lithiasis less or equal to 2 cm.Materials and methodsOne hundred and forty-four operated patients: 101 by “mini-perc” and 43 by URS. Pre-, per- and post-operative data prospectively entered in a computerized database.ResultsURS and “mini-perc” groups were comparable in terms of age (49.2 ± 14 years versus 51.7 ± 16 years; P = 0.37) and of size of the lithiasis (8.5 ± 3.2 mm versus 8.9 ± 2.7 mm, P = 0.4). However, the number of lithiasis was more important in URS group (2.7 ± 141.6 versus 1.3 ± 0.38; P < 0.05). The operating time was 59 ± 32.6 min in URS and 48 ± 28.3 min “mini-perc” group (P = 0.05). The peroperating complication rate was 2% for URS (a false passage during the introduction of the access girdle) and null in the “mini-perc” group. The hospitalization was 1.49 ± 11.4 days after URS and of 4.1 ± 1.2 days after “mini-perc” (P < 0.05). The duration of ureter drainage by stent was respectively 13.8 ± 11.5 and 2.6 ± 1.2 days (P < 0.05). One month later, the treatment was effective in 88% of cases in the URS group whereas 93% in “mini-perc” group (P = 0.17). Six patients (14%) need complementary treatment for residual lithiasis in the URS group and four (3.9%) in the “mini-perc” group.Conclusion The “mini-perc” and the URS are two effective techniques for the treatment of the renal lithiasies less or equal to 2 cm. For the two groups, the complication rates were low and the length of hospital stay was short.
    Progrès en Urologie 02/2011; 21(2):79-84. · 0.77 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Malgré les évolutions technologiques, la lithotritie extracorporelle (LEC) reste aujourd’hui le traitement de première ligne pour la majorité des calculs. Il persiste cependant des situations où le choix de la technique à employer en première intention peut s’avérer difficile. C’est le cas des calculs en situation anatomique particulière ou associés à une anomalie de la voie excrétrice. Les calculs caliciels inférieurs posent encore aujourd’hui un problème de prise en charge optimale : les résultats de la LEC sont insuffisants et la chirurgie percutanée est associée à une morbidité non négligeable malgré ses bons résultats. L’introduction récente de l’urétéroscopie souple-laser amène à rediscuter la place de chacun de ces traitements en fonction de la taille de la nature du calcul caliciel inférieur et des caractéristiques propres du patient et de la voie excrétrice. Le but de cet article a été de faire le point sur la prise en charge des calculs caliciels inférieurs en 2007.
    Progrès en Urologie 12/2008; 18(12):972-976. · 0.77 Impact Factor
  • Source