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Stone size on endoscopic view as a predictor of successful stone retrieval during flexible ureteroscopy: an in vitro analysis

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Abstract

Purpose

Basketing plays an important role during flexible ureteroscopy, but it can be time-consuming, especially when fragments are too large to pass through the ureteral access sheath. We aim to present the optimal on-screen, endoscopic stone size that predicts successful basketing through various access sheaths.

Methods

A tipless basket, individually extended to 5 mm from multiple ureteroscopes: (Flex-Xc, Karl Storz; Flex-X2s, Karl Storz; LithoVue, Boston Scientific; or URF-P6R, Olympus) and via differently sized access sheaths (10–12 Fr through 13–15 Fr), was used in retrieval attempts of various artificial stone sizes (2 mm through 5 mm). A relative endoscopic stone size was recorded as the stone’s maximum diameter on endoscopic view compared to the total image diameter.

Results

Basketing of stones up to 2.5 mm, yielding relative endoscopic stone sizes of 0.38 (Flex-Xc), 0.30 (Flex-X2s), 0.32 (LithoVue), and 0.34 (URF-P6R), was successful using all access sheaths. Only the 12–14 Fr and greater sheaths allowed for successful basketing of 3 mm stones. Larger stones did not successfully pass through any of the access sheaths.

Conclusion

Successful stone retrieval can be predicted by estimating the stone’s size on screen, which is influenced by the type of flexible ureteroscope and access sheath. In our testing, stones of approximately one-third of the screen size passed successfully in all cases.

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Availability of data and materials

All raw data obtained from this study are publicly available and hosted on Zenodo at https://doi.org/10.5281/zenodo.3996881.

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Acknowledgements

We would like to thank the Urology Department at the University of Kansas for the space and resources to conduct our research. All figures were developed using GNU Image Manipulation Program.

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Authors and Affiliations

  1. Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, Mailstop 3016, USA

    J. Hogan Randall, Raphael V. Carrera, David A. Duchene, Kerri L. Thurmon, Donald A. Neff & Wilson R. Molina

  2. School of Medicine, University of Kansas Medical Center, Kansas City, KS, Mailstop 1049, USA

    Paul J. Fletcher

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  1. J. Hogan Randall
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  2. Raphael V. Carrera
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  3. Paul J. Fletcher
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  4. David A. Duchene
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  7. Wilson R. Molina
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Contributions

JHR: protocol and project development; data collection and management; data analysis; manuscript writing and editing. RVC: protocol and project development; data collection; data analysis; manuscript editing. PJF: protocol development; data collection and management; data analysis; manuscript editing. DAD: project development; manuscript editing. KLT: project development; manuscript editing. DAN: project development; manuscript editing. WRM: protocol and project development; manuscript editing.

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Correspondence to J. Hogan Randall.

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Conflict of interest

KL Thurmon has received a speaking honorarium and financial support for attending symposia from Lumenis. WR Molina is a consultant for Olympus, Boston Scientific, and Lumenis. All other named authors have no significant disclosures.

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Randall, J.H., Carrera, R.V., Fletcher, P.J. et al. Stone size on endoscopic view as a predictor of successful stone retrieval during flexible ureteroscopy: an in vitro analysis. World J Urol 39, 3587–3591 (2021). https://doi.org/10.1007/s00345-021-03593-w

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  • DOI: https://doi.org/10.1007/s00345-021-03593-w

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