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

Year 2024, , 1 - 7, 27.02.2024

Mehmet Uslu , Mehmet Ezer , Umit Yildirim Murat Bagcioglu , Kemal Sarıca

https://doi.org/10.33719/nju1339275

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.

Keywords

kidney stone, lower calyx, displacement, basket catheter

Ethical Statement

The study was approved by Ethics Committee of Kafkas University (Approval number: 80576354-050-99/90). The study protocol conformed to the ethical guidelines of the Helsinki Declaration.

Supporting Institution

The authors declared that this study has received no financial support.

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