Ureteroscopic management of lower-pole renal calculi: technique of calculus displacement.
OBJECTIVE
We review our technique of ureteroscopic management of lower pole renal calculi with Nitinol basket displacement and holmium laser stone fragmentation.


METHODS
Lower pole calculi are identified with a 7.5F flexible ureteroscope. In patients in whom the laser fiber reduces ureteroscopic deflection, precluding reentry into the lower pole, a Nitinol basket or grasper is used to displace the calculi into an upper pole calix for easier fragmentation.


RESULTS
The Nitinol device can be passed into the lower pole through the fully deflected ureteroscope without any loss of deflection. Irrigation is significantly reduced by the basket, but this factor does not impede stone retrieval.


CONCLUSIONS
Ureteroscopic management of lower pole stones is a reasonable alternative to SWL or percutaneous nephrolithotomy in low-volume stone disease. If the stone cannot be fragmented in situ, Nitinol basket capture through a fully deflected ureteroscope into a less dependent position facilitates stone fragmentation.
Auge
B K
BK
The Comprehensive Kidney Stone Center, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Dahm
P
P
Wu
N Z
NZ
Preminger
G M
GM
D004867:Equipment Design; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D053685:Laser Therapy; D015607:Stents; D018666:Ureteroscopy / Q000379:methods*; D014572:Urology / Q000295:instrumentation / Q000379:methods