Prevention of retrograde calculus migration with the Stone Cone

Abstract

Retrograde calculus migration during ureteroscopic lithotripsy remains a problem in 5-40% of cases. We assessed the safety and efficacy of the Stone Cone device, in comparison with the standard flat wire basket. A total of 56 consecutive patients with ureteral calculi, suitable for ureteroscopic extraction and/or lithotripsy, where included in this prospective study. Patients were randomly allocated into two groups. In group A (30 patients), we used the Stone Cone, while in group B (26 patients) we used the standard flat wire basket. The Stone Cone was placed through a cystoscope under fluoroscopic guidance, or when necessary under direct ureteroscopic control. Whenever necessary, intracorporeal electrohydraulic lithotripsy took place in both groups. Statistical significance was assessed by the paired t-test. The mean operative time was 48.5 min in group A, and 42.4 min in group B. Intact calculus extraction was possible in 16.6% in group A, and in 7.6% in group B (P < 0.01). Retrograde stone migration was revealed in 23% in group B only (P < 0.001). Also, residual fragments > 3 mm were recorded in 30.7% in group B only (P < 0.001). None of the patients in group A required auxiliary procedures, in contrary to 23% in group B (P < 0.001). No major complications were recorded in group A, while in group B a case of major ureteral mucosal abrasion was recorded. The Stone Cone is safe and efficient in preventing retrograde stone migration and in minimizing residual fragments during ureteroscopic lithotripsy in comparison with the flat wire basket.