Practical comparison of four nitinol stone baskets.

BACKGROUND AND PURPOSE: The use of stone baskets for repositioning of stones or removal of fragment in conjunction with ureterorenoscopy has become widespread. We tested the performance of the ACMI Sur-Catch NT, Bard Dimension, Boston Scientific Zero-tip, and Cook N-Circle in a pig kidney model of flexible ureterorenoscopy. MATERIALS AND METHODS: Opening characteristics of the basket were measured with mechanical calipers at 1-mm increments and compared with published reports to ensure the tested baskets were representative. Pig kidneys were placed in a basin and the ureters secured with a suture to a weight for stability. Flexible renoscopy was performed using a 16F flexible cystonephroscope. An 8-mm calculus was placed in the lower pole. Using each of four designs, the time necessary to grasp the stone, time to release the stone, and total time to move a stone from the lower-pole calix to the upper-pole were recorded. Total time experiments were repeated six times with each basket by three surgeons for a total of 18 attempts, and catch-and-release experiments were repeated six times by four surgeons for a total of 24 attempts per basket. RESULTS: The Sur-Catch was significantly slower for catch and release (P < 0.001) and total time; P < 0.05) compared with all other baskets. There were no differences between the other baskets in either catch, release, or total times. There was no difference between surgeons (P < 0.0634) or between attempts one through six (P = 0.538). CONCLUSIONS: Baskets with added complexity of the wire configurations (Sur-Catch) or a deflectable-wire mechanism (Dimension) offer no advantages and may slow capture and release of stones.

Comparison of Peditrol irrigation device and common methods of irrigation.

BACKGROUND AND PURPOSE: The Peditrol is a novel hands-free irrigation device that delivers a bolus of irrigant through the ureteroscope when the foot pedal is deployed. The purpose of this study was to compare the flow and pressures created by the Peditrol with those of commonly used methods of irrigation. MATERIALS AND METHODS: Flows through a flexible 6.9F Olympus ureteroscope (F-URS) and a 7.5F semirigid ACMI ureteroscope (S-URS) were measured in duplicate with the working channel empty and with a 2.2F Nitinol basket or a laser fiber in the working port. Irrigant flow was pressurized by gravity drainage at 100 cm H(2)O (GI), pressurized irrigant bag at 300 cm H(2)O (PI), handheld 60-cc syringe (HS), and the Peditrol. A 20-gauge angiocatheter was placed through the parenchyma into the renal pelvis of an ex-vivo cadaveric porcine kidney and attached to a pressure transducer. Pressures were measured in triplicate using the same irrigation techniques. RESULTS: With a basket or 200-microm laser fiber in the working port of the F-URS, Peditrol mean flows were superior to those of PI (3.3 and 6.3 times, respectively; P < 0.001) but similar to those of HS (0.7 to 1.1 times). All irrigation types resulted in intrarenal pressures greater than gravity irrigation (P < 0.05). The Peditrol demonstrated intrapelvic pressures <40 cm H(2)O when used with a 12/14F ureteral access sheath (AS). Without an AS, the intrapelvic pressure reached 92 cm H(2)O, similar to the pressures reached with the S-URS under various irrigation conditions (84-287 cm H(2)O) and comparable to the HS method through the F-URS (97 cm H(2)O). CONCLUSIONS: The Peditrol irrigation device generates superior flow through an F-URS compared with GI or PI, particularly with an instrument in the working port. Intrarenal pressures when used with an F-URS and AS are low. When an AS is not used, the intrarenal pressure is similar to or lower than pressures obtained using an S-URS with different irrigation modalities.

Semirigid ureteroscopy of the proximal ureter can be aided by external lower-abdominal pressure.

BACKGROUND AND PURPOSE: Smaller semirigid ureteroscopes with large working channels and excellent optics are widely available. Ureteroscopic treatment of upper-ureteral stones has become increasingly popular, although flexible ureteroscopy is more frequently the method of choice. Access to the upper ureter with a semirigid ureteroscope (SR-URS) can be challenging and hazardous, especially when negotiating the iliac vessels. We sought to determine whether lower-abdominal pressure (LAP) facilitated SR-URS access to the upper ureter for safe laser lithotripsy. PATIENTS AND METHODS: Thirty-two consecutive patients who underwent ureteroscopic management of upper- ureteral stones were evaluated. Twenty-four (75%) were male; seventeen (53%) had a right-sided stone. The mean largest stone diameter was 10.2 +/- 4.6 mm. These 32 patients were compared with a matched cohort of patients who underwent SR-URS procedures without the use of LAP. RESULTS: Access to the upper ureter was possible in 30 patients (94%). The LAP was helpful in 18 patients (56%): it facilitated passage of the SR-URS in 16 patients (50%) and laser fiber placement in 11 cases (34%). Access to the upper ureter was possible in all women. The mean operative time was 54 minutes in the LAP group and 75 minutes in the matched cohort without LAP (P = 0.026). There were no significant deformities of the SR-URS and no complications. CONCLUSIONS: Contrary to popular practice, the upper ureter can be accessed safely and efficiently with a 7.5F SR-URS in nearly all patients. Lower-abdominal pressure can be helpful to negotiate passage of the endoscope over the iliac vessels or to place the laser fiber on stones.

Vaso-cutaneous fistula after vasectomy.

Vaso-cutaneous fistulae occur rarely after vasectomy. We report three cases encountered in our hospital over the last 18 years and recommend technical considerations to avoid this complication.

Metastatic renal cell carcinoma regression after nephrectomy and BCG immunotherapy.

Patients with renal cell carcinoma (RCC) often remain asymptomatic until the disease has progressed beyond the confines of the kidney, as almost one third of patients have metastatic disease at the time of diagnosis.1 The average survival for a patient presenting with metastatic renal cell carcinoma is 4 months and only 10% will be alive at 1 year.2 Many different treatment combinations have tried for metastatic disease, but with limited results. Some success has been shown in smaller studies using nephrectomy and Bacillus Calmette-Guerin (BCG) immunotherapy but these results have not been followed by larger randomized control trials.3 We report a case metastatic renal cell carcinoma with an unusually long survival and regression of metastases from 2 uncommon sites.

Combined percutaneous and endoscopic management of the distally ligated ureter.

While combined percutaneous and endoscopic techniques have been described previously as a means of dealing with the distally strictured ureter, this report confirms that these approaches can also be used successfully in the management of the very distally ligated ureter in the early post-injury period.