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The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience.
J Urol. 2002 May; 167(5):1985-8.JU

Abstract

PURPOSE

Retrograde stone migration during ureteroscopic lithotripsy occurs in 5% to 40% of proximal and distal ureteral stone cases. This migration increases morbidity and the need for auxiliary procedures. The Dretler stone cone (Medsource, Norwell, Massachusetts) is a novel device to prevent proximal stone migration and facilitate fragment extraction during ureteroscopic lithotripsy. We assessed the safety and efficacy of the Dretler stone cone in the clinical setting and compared it prospectively with a conventional flat wire basket during ureteroscopy for ureteral calculi.

MATERIALS AND METHODS

To our knowledge we report the initial clinical use of the Dretler stone cone in 50 consecutive patients with ureteral calculi undergoing ureteroscopic extraction. Calculi were situated above the sacroiliac joint in 24 cases, over the sacroiliac joint in 15 and below the sacroiliac joint in 11. Pneumatic lithotripsy was done in 42 cases. In the remaining 8 cases ureteroscopic (3) or fluoroscopic (5) intact stone extraction was performed. The later 23 cases using the Dretler stone cone were prospectively compared with 20 of ureteroscopic intracorporeal lithotripsy using a standard flat wire basket.

RESULTS

The Dretler stone cone was successfully placed in all 50 cases. In 41 patients it was placed via cystoscopy under fluoroscopic guidance, while 9 impacted stones required ureteroscopic placement. Six patients in whom the Dretler stone cone was used had residual fragments less than 3 mm. No patient required auxiliary procedures. In the prospective trial no patients in Dretler stone cone group had residual fragments greater than 3 mm. or required auxiliary procedures. However, in the flat wire basket group residual stones greater than 3 mm. were present in 6 cases (30%, p <0.001), while auxiliary procedures were required in 4 (20%, p <0.01).

CONCLUSIONS

The Dretler stone cone represents a new generation of basketry that minimizes proximal ureteral stone migration and allows safe extraction of fragments during ureteroscopic lithotripsy. In our experience it is associated with a lower incidence of significant residual fragments and fewer auxiliary procedures than conventional flat wire baskets.

Authors+Show Affiliations

Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11956424

Citation

Desai, Mahesh R., et al. "The Dretler Stone Cone: a Device to Prevent Ureteral Stone Migration-the Initial Clinical Experience." The Journal of Urology, vol. 167, no. 5, 2002, pp. 1985-8.
Desai MR, Patel SB, Desai MM, et al. The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience. J Urol. 2002;167(5):1985-8.
Desai, M. R., Patel, S. B., Desai, M. M., Kukreja, R., Sabnis, R. B., Desai, R. M., & Patel, S. H. (2002). The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience. The Journal of Urology, 167(5), 1985-8.
Desai MR, et al. The Dretler Stone Cone: a Device to Prevent Ureteral Stone Migration-the Initial Clinical Experience. J Urol. 2002;167(5):1985-8. PubMed PMID: 11956424.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Dretler stone cone: a device to prevent ureteral stone migration-the initial clinical experience. AU - Desai,Mahesh R, AU - Patel,Sanjiv B, AU - Desai,Mihir M, AU - Kukreja,Rajesh, AU - Sabnis,Ravindra B, AU - Desai,Rasesh M, AU - Patel,Snehal H, PY - 2002/4/17/pubmed PY - 2002/5/1/medline PY - 2002/4/17/entrez SP - 1985 EP - 8 JF - The Journal of urology JO - J Urol VL - 167 IS - 5 N2 - PURPOSE: Retrograde stone migration during ureteroscopic lithotripsy occurs in 5% to 40% of proximal and distal ureteral stone cases. This migration increases morbidity and the need for auxiliary procedures. The Dretler stone cone (Medsource, Norwell, Massachusetts) is a novel device to prevent proximal stone migration and facilitate fragment extraction during ureteroscopic lithotripsy. We assessed the safety and efficacy of the Dretler stone cone in the clinical setting and compared it prospectively with a conventional flat wire basket during ureteroscopy for ureteral calculi. MATERIALS AND METHODS: To our knowledge we report the initial clinical use of the Dretler stone cone in 50 consecutive patients with ureteral calculi undergoing ureteroscopic extraction. Calculi were situated above the sacroiliac joint in 24 cases, over the sacroiliac joint in 15 and below the sacroiliac joint in 11. Pneumatic lithotripsy was done in 42 cases. In the remaining 8 cases ureteroscopic (3) or fluoroscopic (5) intact stone extraction was performed. The later 23 cases using the Dretler stone cone were prospectively compared with 20 of ureteroscopic intracorporeal lithotripsy using a standard flat wire basket. RESULTS: The Dretler stone cone was successfully placed in all 50 cases. In 41 patients it was placed via cystoscopy under fluoroscopic guidance, while 9 impacted stones required ureteroscopic placement. Six patients in whom the Dretler stone cone was used had residual fragments less than 3 mm. No patient required auxiliary procedures. In the prospective trial no patients in Dretler stone cone group had residual fragments greater than 3 mm. or required auxiliary procedures. However, in the flat wire basket group residual stones greater than 3 mm. were present in 6 cases (30%, p <0.001), while auxiliary procedures were required in 4 (20%, p <0.01). CONCLUSIONS: The Dretler stone cone represents a new generation of basketry that minimizes proximal ureteral stone migration and allows safe extraction of fragments during ureteroscopic lithotripsy. In our experience it is associated with a lower incidence of significant residual fragments and fewer auxiliary procedures than conventional flat wire baskets. SN - 0022-5347 UR - https://www.unboundmedicine.com/medline/citation/11956424/The_Dretler_stone_cone:_a_device_to_prevent_ureteral_stone_migration_the_initial_clinical_experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(05)65069-0 DB - PRIME DP - Unbound Medicine ER -