Anti-Retropulsion device use for prevention of Proximal stone migration during laser Lithotripsy- Case Report

Abstract

Introduction: Retropulsion and stone fragment migration is a problem with lithotripsy for proximal and mid ureteric calculi during ureteroscopy, leading to increased operative time, costs and number of additional procedures. To overcome this drawback, many strategies have been developed, one of which is the use of anti-retropulsion devices. Objective: To describe the use of an anti-retropulsion device during holmium laser lithotripsy in a patient with mid ureteric stone. Case History: A 48-year old male patient, with recurrent history of recurrent colicky left flank pain. Abdominal CT scan with CT urography showed a 1.5 cm x 9.7mm impacted calculus in the left upper ureter with proximal pre- stenotic dilation associated with hydronephrosis and hydroureter. He had ureteroscopy with combined spinal and epidural anesthesia. Considering the high risk of retropulsion, the Boston Scientific Stone Cone Nitinol Retrieval Coil was passed beyond the stone and deployed under fluoroscopy to prevent proximal stone and fragment migration. Holmium laser lithotripsy was then carried out using combine hard stone and dusting modes with complete stone clearance. A double J stent was passed. The total operating time was 55minutes. Conclusion: Anti-retropulsion devices are safe and cost-effective tools during ureteroscopy and lithotripsy for ureteric stones with high risk for retropulsion.