Category: Stones: Ureteroscopy
Introduction & Objective :
Ureteroscopy with laser lithotripsy is considered the primary treatment in managing distal ureteral stones. However, the size of the stone can vary, with larger stones creating the dilemma of risks and benefits. With an emerging role of instrumentation in endourology, we wanted to evaluate the use of the Suction Handpiece (Lumenis®) in treating large distal ureteral stones. We are presenting a case illustrating the use of the Suction HandPiece via a nephroscope in a retrograde fashion for the management of a 4cm distal ureteral stone.
A 60 year-old male with history of HTN, HLD and arthritis was referred to our institution after she was diagnosed with a 4cm right distal ureteral stone. At the time she was afebrile, had a normal white blood cell count and creatinine and no evidence of infection. She underwent a percutaneous nephrostomy tube placement and attempted ureteral stent placement which was unsuccessful. She underwent a cystoscopy and retrograde use of the Suction HandPiece with clearance of her distal stone and placement of 2 double J stents.
Results : Procedure was tolerated well. All stone was removed in a retrograde fashion and confirmed on a 1 month post op CT. Stone composition was calcium oxalate. Her stents were removed 1 month post op. She is now 1 year removed from the surgery with no new stone events and UTI’s or episodes of pyelonephritis. Patient remains under close surveillance given high risk of stricture.
Conclusions : Retrograde use of the Suction HandPiece via a nephroscope is feasible and can be done in a select group of patients.
New York, New York
Mark V. Silva, MD
NYU Dept. of Urology
New York, NY