Stone Baskets and Forceps
Stone extraction devices are an important part of ureteroscopic stone extraction and laser lithotripsy. The instruments have evolved significantly as more advanced and miniaturized flexible ureteroscopes have been developed. Currently, tipless nitinol stone baskets are available from a number of manufacturers. The nitinol baskets do not affect the deflection of the flexible ureteroscope and can also be used with semirigid ureteroscopes. There is a reduction in the flow of irrigant with the use of stone extraction devices, but this is proportional to the size of the device. Nitinol baskets are safe for use in all parts of the collecting system and should be considered a standard first choice when a stone basket is used. Dormia helical and Segura flatwire baskets remain available commercially and may be useful in select cases but are not commonly used.
Antiretropulsion devices, as well as BackStop (Cook Urological, Bloomington, IN, USA) and basket retention of a stone during laser lithotripsy, can reduce the migration of ureteral stones to the kidney during ureteroscopic lithotripsy and help to avoid additional procedures. For the three devices available, some data is available showing safety, however further clinical studies are required to establish whether their routine use for ureteral stones is warranted and cost effective.
The most feared complication of the use of stone extraction devices is ureteral avulsion. The use of these devices and stone extraction should only be performed under direct vision, while observing the urothelium slide over the stone. If basket impaction occurs, no further traction should be applied to the basket. Laser can be applied to the stone or the basket itself.
KeywordsUreteral Stone Laser Lithotripsy Flexible Ureteroscopes Ureteral Access Sheath Stone Basket
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