Comparison of flexible grasping forceps and stone basket for removal of retracted ureteral stents.

BACKGROUND: Ureteral-stent dislocation can occur either during positioning or postoperatively. Grasping the distal end of the stent and removing it depends on the angulation between the extraction device and the stent, the size and length of the instrument, and the force of the branches and resistance of the dislocated stent. PATIENTS AND METHODS: Six cases of challenging stent removal are presented, and details of the surgical technique are described. By in-vitro testing, we investigated the deflection of flexible cystoscopes and ureteroscopes using forceps or a four-wire stone basket, the ability to grasp a stent depending on the angle between the stent axis and the extraction device, and the force that can be applied on the stent with the different devices. RESULTS: In all cases, it was possible to extract the stent with a stone basket. In an in-vitro setting, maximum extraction forces, measured with a macro scale, were 1.3 kg (cystoscopic forceps) and 0.4 kg (ureteroscopic forceps) until the forceps slipped off the stent. In the same setting, a rupture of the wires of the 1.9F stone basket occurred at 0.8 kg, whereas with a 2.4F basket, a force of 1.9 kg led to rupture of the stent, leaving the basket intact. CONCLUSIONS: Using a stone basket instead of grasping forceps in difficult cases of dislocated stents opens new possibilities for their cystoscopic and ureteroscopic removal. Because the superiority of the basket is counterbalanced by its higher costs, we suggest the basket extraction method only in difficult cases.

Introducing a novel technique to remove accidentally stitched or entrapped urethral catheters after radical prostatectomy.

INTRODUCTION: A crucial step during radical prostatectomy is anastomosing the bladder neck to the urethral stump after specimen removal. For this purpose, a Foley catheter is inserted transurethrally to achieve a patent and watertight anastomosis. The catheter should be removed 6-10 days after the procedure to avoid ascending infection and stricture formation. On occasion, catheter removal is not possible due to fixation by one of the anastomotic sutures. In this case, a longer catheterization period may increase the risk of infection and formation of an anastomotic stricture. MATERIALS AND METHODS: In the present report, we suggest a technique to overcome this problem by using an endoscopic laser dissection of the anastomotic suture. In 2 patients, a 4.8-Fr pediatric ureteroscope was passed through the urethra along the fixated catheter. After carefully inspecting the anastomosis, a laser fiber was brought in direct contact with the responsible suture. RESULTS AND CONCLUSIONS: By activating the laser, the suture was cut immediately, and the catheter could be removed. Both patients showed no signs of anastomotic leakage or stricture on cystography. Fixation of the catheter after radical prostatectomy is a rare, but bothersome complication, which can compromise the functional outcome of the procedure. Using a pediatric ureteroscope and a laser fiber is an elegant, minimally invasive method to solve this problem. It can be easily and safely performed under local anesthesia in an outpatient setting.