A New Technique for the Entrapped Stone Basket: Tap and Roll

Abstract

Introduction:

Despite technological advances in endoscopes, stone basket entrapment is still a problem for urologists. Methods to free the basket with laser or shockwave lithotripsy have been published. ^{1 –5} Using a simple ex vivo model, we describe and demonstrate preliminary experiments, using readily available instrumentation, that warrant further study for clinical applicability, specifically in those circumstances where a laser is not available to fragment the stone or basket.

Materials and Methods:

A nitinol flat wire 2.4F, nitinol tipless 1.5F, stainless steel flat wire 3.0F, and stainless steel paired helical 3.0F were used in a silicon tube ureteral model. A 4-mm chrome ball was positioned inside the cage of the bare basket wire and placed in the ureteral model. A flexible ureteroscope or rigid ureteroscope was utilized to reach the entrapped basket in the mock ureter. Three different techniques—reverse guidewire method Tap and Roll, reverse guidewire with torque drive wire method, and 3-prong grasper method—were applied to release the entrapped basket.

Results:

The reversed guidewire method Tap and Roll (video 1) was successful for both nitinol baskets and the stainless steel paired helical basket. The reversed guidewire with torque drive wire method (video 2) was successful for the nitinol flat wire and stainless steel paired helical basket. The grasper method (video 3) was successful for both the nitinol baskets and the stainless steel paired helical basket.

Conclusions:

Release of the entrapped stone basket is a challenging situation to the endourologist. We describe some simple methods of disengagement that with further study may be clinically useful, especially in situations where shockwave and laser lithotripsy are not available.

All authors have declared that no competing financial interests exist.

Runtime of video: 4 mins 13 secs