Effect of positioning on ureteric stone retropulsion: 'gravity works'.

Abstract:

OBJECTIVE:To evaluate the potential impact of alterations in 'patient' position on laser-induced ureteric stone retropulsion in an in vitro model. MATERIALS AND METHODS:A ceramic (phantom) stone was placed in a water-filled clear polymer tube and subjected to continuous laser energy until the stone had retropulsed a distance of 10 cm. The trial was stopped after 60 s if the stone had not reached 10 cm. The time and total energy needed to cause 10 cm of retropulsion were recorded at incline angles of 0°, 10°, 20°, and 40°; 10 trials at each angle were completed. The study was then repeated with pure calcium phosphate brushite stones. RESULTS:Retropulsion decreased with increasing incline angle of the saline-filled clear polymer tube. At 0° of incline the phantom stone reached a distance of 10 cm after 7.4 s. At 10°, 20° and 40°, the phantom stone migrated a mean maximum distance of 3.1, 1.2 and 0.7 cm, respectively, and the trial was stopped after 60 s. For the calcium phosphate stone, at 0° and 10° of incline, the stone reached 10 cm after 6.9 and 42.8 s, respectively (P < 0.05). At 20° and 40°, the calcium phosphate stone moved a mean maximum distance of 2.4 and 1 cm, and the trial was stopped after 60 s. CONCLUSION:Alterations in the angle of inclination reduced stone retropulsion during ureteroscopic lithotripsy in an in vitro model to <1 cm. Increasing the incline angle of a patient may effectively preclude retropulsion when performing laser lithotripsy of ureteric stones.

journal_name

BJU Int

journal_title

BJU international

authors

Patel RM,Walia AS,Grohs E,Okhunov Z,Landman J,Clayman RV

doi

10.1111/bju.14510

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

113-117

issue

1

eissn

1464-4096

issn

1464-410X

journal_volume

123

pub_type

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