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Preventing stone retropulsion during intracorporeal lithotripsy

Nature Reviews Urology volume 9, pages 691–698 (2012)Cite this article

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Abstract

Several studies of ureteroscopic treatment for ureteral stones have reported that most stone clearance failures can be attributed to stone fragment retropulsion. Stone retropulsion can result in increased operative time and cost—resulting from the need to change from the semi-rigid ureteroscope to a flexible instrument to chase migrated calculi—and additional procedures to treat residual migrated fragments are often required. The degree of migration depends mainly on the energy source used for lithotripsy; pneumatic and electrohydraulic lithotripters are associated with a greater degree of retropulsion than lasers. Different stone-trapping strategies and devices have been developed to minimize stone migration. Novel devices include the Lithovac® suction device, the Passport™ balloon, the Stone Cone™, the PercSys Accordion®, the NTrap®, and stone baskets such as the LithoCatch™, the Parachute™, and the Escape®. Some authors have also reported on the use of lubricating jelly and BackStop® gel (a reverse thermosensitive polymeric plug); these devices are instilled proximal to the stone prior to the application of kinetic energy in order to prevent retrograde stone migration.

Key Points

  • Retrograde stone retropulsion is relatively common during the endoscopic management of proximal ureteral calculi (28–60% incidence) and distal calculi (3–15% incidence), regardless of lithotripter type

  • The use of an antiretropulsion device is essential when dealing with proximal ureteral calculi or calculi with proximally dilated ureter

  • The choice of antiretropulsion device should be based on the type of ureteroscopy, type of lithotripter, ureteral diameter, and surgeon experience

  • For patients with proximally dilated ureters, the 10 mm Stone Cone™ and 10 mm PercSys Accordion® device seem to be associated with greater clinical success than other devices

  • For patients with distal ureteric stones, routine use of an antiretropulsion device could reduce mean operative time and increase stone-free rates

  • Further efforts are still required to produce a safe and effective antiretropulsion device, as well as a lithotripsy energy source with lower retropulsion rates

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Figure 1: Product catalogue image of Escape®—a 1.9 F, zero-tip, four-wire nitinol stone retrieval basket.
Figure 2: Product catalogue image of Lithocatch—a 12-wire helical mesh basket with a sheath outer diameter of 2.2 F.
Figure 3: Product catalogue image of Parachute—a multiwire stone retrieval basket that has an outer diameter of 3.1 F and either a zero-tip or a 5 cm filiform wire tip.
Figure 4: Product catalogue image of Passport—a noncompliant balloon with specially treated polymers to maintain its outer diameter during controlled inflation.
Figure 5: Product catalogue images of PercSys Accordion®.
Figure 6: Product catalogue image of NTrap®, which is composed of an inner wire and outer sheath catheter.

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  1. 19 Elmoderia Street, Teeba Tower, Suite 10, Tanta, 31111, Egypt

    Osama M. Elashry & Ahmad M. Tawfik

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Correspondence to Osama M. Elashry.

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Elashry, O., Tawfik, A. Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol 9, 691–698 (2012). https://doi.org/10.1038/nrurol.2012.204

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