A Novel Technique for Relocating Renal Lower Calyceal Stones During Retrograde Intrarenal Surgery: ‘’Jab and Pull’’

Abstract

Objective : It is advised to move the stones from the lower calyx to the middle or upper calyx using a nitinol basket. In order to protect the flexible ureterorenoscopy and increase the stone-free rate during retrograde intrarenal surgery In this descriptive study, we presented a method for moving stones to other calyces where the need for deflection is less, using holmium fiber in cases where the nitinol basket is not available. Materials and Methods: With the “Jab and Pull” method we have described, 32 patients who underwent RIRS for symptomatic (pain or infection) renal lower calyceal stones with a diameter of 4-10 mm in our clinic, between 2012 and 2021 were retrospectively analyzed. Demographic data, stone size, Hounsfield unit, number of stones, opaque non-opaque status, stone localization, infundibulopelvic angle, perioperative-postoperative complications, and control imaging were evaluated. Results: The mean age of the patients was 51.12, and the female-male ratio was equal. The median stone size was 8mm (min:5, max:10), and the Hounsfield unit was 805 (±396.72). 75% (24) of the stones were single and 53.1% (17) were opaque. The median infundibulopelvic angle was 38 (min:19 max:52) degrees. 27 (84.4%) patients achieved stone-free status using this method. The renal lower calyx neck of two patients was too narrow, the stones of two patients were too soft, and the stone of one patient was inaccessible, preventing total success in these patients. Conclusions: In cases where a nitinol basket is needed but cannot be reached during treatment of kidney lower calyx stones, the “jab and pull” method can be considered as an alternative in suitable patients.