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Stone basket rescue
STONE BASKET RESCUE* MAJ. MICHAEL MAJ. R. VINCE
E. BEALL KIDD
(MC) USAF
(MC) USAF
From the Department of Surgery, Urology Service, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas
ABSTRACT -A case report is presented in which a Dormia stone basket tip was broken retained during a stone manipulation. It was successfully retrieved from the distal ureter alligator forceps underjuoroscopic guidance.
off and with an
The risks of transurethral ureteral calculus manipulation are legion. This case report describes a unique solution of an uncommon complication encountered during a stone basket manipulation. Case Report A thirty-seven-year-old white man was seen because of intermittent right flank pain of five months’ duration. Findings on physical examination revealed mild right flank tenderness. The patient was afebrile. Urinalysis showed 40 to 50 red blood cells per high-powered field; the urine was sterile. An intravenous pyelogram revealed a 4 by S-mm. right distal ureteral calculus with minimal obstruction. Stone manipulation was performed on November 28, 1977. The Johnson basket was passed with extraction of about one-half the calculus. Since the remaining fragment was small, the Pfister-Schwartz basket was passed once, but no stone was removed. For a final pass the Dormia basket was inserted. A sudden pop was felt during the extraction. To our dismay, the open broken wires of the basket emerged from the ureteral orifice (Fig. 1); an xray film was obtained (Fig. 2).
*The views expressed and do not necessarily States Air Force.
590
herein are those reflect the views
of the authors of the United
FIGURE
Broken Dormia and j&form retrieved.
1.
Under fluoroscopic control, the Johnson basket was introduced. The filiform was engaged and brought to within 2 cm. of the orifice but could not be extracted. Therefore, alligator forceps were inserted into the orifice. With fluoroscopic assistance the forceps were advanced, and the broken end of the filiform was grasped and removed. Bulb ureterogram demonstrated questionable extravasation. A 5-F ureteral catheter was passed and left indwelling for forty-eight hours. Twenty-four hours after removal of the catheter, the patient spiked high fevers. An intravenous pyelogram revealed partial ureteral
UROLOGY
/
fUNE 1981
/
\‘OLUME XVII, NUMBER 6
The major complication rate complication. in most series is about 10 per cent. The minor complication rate varies from 27 to 54 per cent.3’5*6 The reported complications in approximate descending order of frequency are: renal colic, bacteriuria, retained calculus, repeat manipulation, cardiovascular disorders, bacteremia, urethrolithotomy, wound drainage (infection), pyelonephritis, pyonephrosis, ureteral perforation, nephrectomy, reflux, wedged stone basket, ureteral avulsion, broken stone basket tip, stricture of ureter, and death.‘eY We could find only 2 published cases of broken stone basket tips.‘a4 Both retained tips were removed at open surgery. Our case appears to be the first reported to retrieve a broken basket tip endoscopically. Why the Dormia basket broke is unclear. Undue force was not exerted during the manipulation. Use on multiple previous occasions may have weakened it. A careful inspection of each basket is warranted, and any doubtful or older instruments should be discarded. 410 Maple Avenue West Vienna, Virginia 22180 (DR. BEALL) Ref’erencrs
X-raq film (KUB) in distal right ureter. FIGURE
2.
I
I
shows broken Jilifurm
obstruction, so a 5-F catheter was The patient’s condition improved ture of the urine showed greater Pseudomonas. Gentamicin and were administered. The patient is
again passed. rapidly. Culthan 100,000 carbenicillin pain free.
Comment The success rate of ureteral stone manipulation is reported to be between 45 and 91 per cent in various series. I-5 We were only partially successful. The multiple passes led to our
1. Fetter TR, Zirnskind PD, Graham RH, and Brodie DE: Statistical analysis of patients with nretrral calwli, JAMA 186: 21 (19631. 1. Fox M, Pyrah LN, and Raper FP: Management of ureteric stone: a revielv of 292 cases, Br. J. Ural. 37: 660 (1965). 3. Furlow \f’L, and Bucchiere JJ: The srq$cal fate of ureteral calculi: review of Mayo Clinic experience, J. Ural. 116: 559 (1976). 4. Prince CL, and Scardino PL: A statistical analysis of nreteral calcrdi. ihid. 83: 561 (1960). 5. Mahon FB, and b’aters RF: A critical review of stone manipulation: a five-year study, ibid. 110: 387 (1973). 6. Nourse MH: The management of ureteml stones, JAMA 198: 132 (19661. 7. Ahdelsayed Xl, and Onal E: .4vulsion of the rlreter by stone J, Vrol. 118: 868 (1977). basket manipulation, 8. Hodge J: Avnlsion of long segment of rlwter with Dormia basket. Br. J, Urol. 45: 328 (19731. 9. Hart JB: Awlsion of distal uretrr with Dormia basket. J. I‘rol. 97: 62 (1967).
591
E. BEALL KIDD
(MC) USAF
(MC) USAF
From the Department of Surgery, Urology Service, Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, Texas
ABSTRACT -A case report is presented in which a Dormia stone basket tip was broken retained during a stone manipulation. It was successfully retrieved from the distal ureter alligator forceps underjuoroscopic guidance.
off and with an
The risks of transurethral ureteral calculus manipulation are legion. This case report describes a unique solution of an uncommon complication encountered during a stone basket manipulation. Case Report A thirty-seven-year-old white man was seen because of intermittent right flank pain of five months’ duration. Findings on physical examination revealed mild right flank tenderness. The patient was afebrile. Urinalysis showed 40 to 50 red blood cells per high-powered field; the urine was sterile. An intravenous pyelogram revealed a 4 by S-mm. right distal ureteral calculus with minimal obstruction. Stone manipulation was performed on November 28, 1977. The Johnson basket was passed with extraction of about one-half the calculus. Since the remaining fragment was small, the Pfister-Schwartz basket was passed once, but no stone was removed. For a final pass the Dormia basket was inserted. A sudden pop was felt during the extraction. To our dismay, the open broken wires of the basket emerged from the ureteral orifice (Fig. 1); an xray film was obtained (Fig. 2).
*The views expressed and do not necessarily States Air Force.
590
herein are those reflect the views
of the authors of the United
FIGURE
Broken Dormia and j&form retrieved.
1.
Under fluoroscopic control, the Johnson basket was introduced. The filiform was engaged and brought to within 2 cm. of the orifice but could not be extracted. Therefore, alligator forceps were inserted into the orifice. With fluoroscopic assistance the forceps were advanced, and the broken end of the filiform was grasped and removed. Bulb ureterogram demonstrated questionable extravasation. A 5-F ureteral catheter was passed and left indwelling for forty-eight hours. Twenty-four hours after removal of the catheter, the patient spiked high fevers. An intravenous pyelogram revealed partial ureteral
UROLOGY
/
fUNE 1981
/
\‘OLUME XVII, NUMBER 6
The major complication rate complication. in most series is about 10 per cent. The minor complication rate varies from 27 to 54 per cent.3’5*6 The reported complications in approximate descending order of frequency are: renal colic, bacteriuria, retained calculus, repeat manipulation, cardiovascular disorders, bacteremia, urethrolithotomy, wound drainage (infection), pyelonephritis, pyonephrosis, ureteral perforation, nephrectomy, reflux, wedged stone basket, ureteral avulsion, broken stone basket tip, stricture of ureter, and death.‘eY We could find only 2 published cases of broken stone basket tips.‘a4 Both retained tips were removed at open surgery. Our case appears to be the first reported to retrieve a broken basket tip endoscopically. Why the Dormia basket broke is unclear. Undue force was not exerted during the manipulation. Use on multiple previous occasions may have weakened it. A careful inspection of each basket is warranted, and any doubtful or older instruments should be discarded. 410 Maple Avenue West Vienna, Virginia 22180 (DR. BEALL) Ref’erencrs
X-raq film (KUB) in distal right ureter. FIGURE
2.
I
I
shows broken Jilifurm
obstruction, so a 5-F catheter was The patient’s condition improved ture of the urine showed greater Pseudomonas. Gentamicin and were administered. The patient is
again passed. rapidly. Culthan 100,000 carbenicillin pain free.
Comment The success rate of ureteral stone manipulation is reported to be between 45 and 91 per cent in various series. I-5 We were only partially successful. The multiple passes led to our
1. Fetter TR, Zirnskind PD, Graham RH, and Brodie DE: Statistical analysis of patients with nretrral calwli, JAMA 186: 21 (19631. 1. Fox M, Pyrah LN, and Raper FP: Management of ureteric stone: a revielv of 292 cases, Br. J. Ural. 37: 660 (1965). 3. Furlow \f’L, and Bucchiere JJ: The srq$cal fate of ureteral calculi: review of Mayo Clinic experience, J. Ural. 116: 559 (1976). 4. Prince CL, and Scardino PL: A statistical analysis of nreteral calcrdi. ihid. 83: 561 (1960). 5. Mahon FB, and b’aters RF: A critical review of stone manipulation: a five-year study, ibid. 110: 387 (1973). 6. Nourse MH: The management of ureteml stones, JAMA 198: 132 (19661. 7. Ahdelsayed Xl, and Onal E: .4vulsion of the rlreter by stone J, Vrol. 118: 868 (1977). basket manipulation, 8. Hodge J: Avnlsion of long segment of rlwter with Dormia basket. Br. J, Urol. 45: 328 (19731. 9. Hart JB: Awlsion of distal uretrr with Dormia basket. J. I‘rol. 97: 62 (1967).
591