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Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi.
Urology. 2000 Dec 20; 56(6):935-9.U

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-micrometer 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.

Authors+Show Affiliations

Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11113736

Citation

Kourambas, J, et al. "Nitinol Stone Retrieval-assisted Ureteroscopic Management of Lower Pole Renal Calculi." Urology, vol. 56, no. 6, 2000, pp. 935-9.
Kourambas J, Delvecchio FC, Munver R, et al. Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi. Urology. 2000;56(6):935-9.
Kourambas, J., Delvecchio, F. C., Munver, R., & Preminger, G. M. (2000). Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi. Urology, 56(6), 935-9.
Kourambas J, et al. Nitinol Stone Retrieval-assisted Ureteroscopic Management of Lower Pole Renal Calculi. Urology. 2000 Dec 20;56(6):935-9. PubMed PMID: 11113736.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nitinol stone retrieval-assisted ureteroscopic management of lower pole renal calculi. AU - Kourambas,J, AU - Delvecchio,F C, AU - Munver,R, AU - Preminger,G M, PY - 2000/1/11/pubmed PY - 2001/3/3/medline PY - 2000/1/11/entrez SP - 935 EP - 9 JF - Urology JO - Urology VL - 56 IS - 6 N2 - 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-micrometer 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. SN - 1527-9995 UR - https://www.unboundmedicine.com/medline/citation/11113736/Nitinol_stone_retrieval_assisted_ureteroscopic_management_of_lower_pole_renal_calculi_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0090-4295(00)00821-9 DB - PRIME DP - Unbound Medicine ER -