Antegrade Use of Stone Dislodger

Kim, Young Soo

Abstract

The antegrade manipulation with stone dislodger was applied in 7 cases of unilateral multiple ureteral calculi or ureteral calculi accompanied with ipsilateral renal calculi who were admitted to the Department of Urology, Korea University Hospital during the period of 3 years and 7 months from August 1975 to March 1979. After surgical operation including pyelolithotomy, partial nephrectomy or ureterolithotomy for removal of proximal calculi, stone dislodger was passed downward to the distal calculi through the opening made in the kidney pelvis or ureter. When loop catheter is used a sufficient length of catheter is passed to ensure placement of the loop segment is in the bladder. When the stone is snared, a slow and gentle withdrawal motion will facilitate extraction. Compared with the cystoscopic manipulation, the antegrade use of stone dislodger had advantages and high success rate. Results and advantages are described below. 1. In six cases among seven, distal stone was extracted successfully with this procedure. 2. Among the six successful cases, one was upper ureteral stone and five were lower ureteral stones. 3. Each case had one distally located stone in the ureter and the largest one among them was 0.7 X 0.9cm in size. 4. No specific complications were noted during or after procedure in all six cases 5. Advantages of the antegrade manipulation were as followings. 1) Calculi which was snared, could be extracted without difficulty or ureteral trauma because the ureter proximal to the calculi was usually dilated. 2) Appropriate control of traction power and easy manipulation could be performed. 3) When loop catheter was used it was safe because the loop was formed in wide space of the urinary bladder. 4) There was no urethral injury. 5) Another surgical procedure or retrograde cystoscopic manipulation for removal of distal calculi was not necessary.