Randall J Hogan, Carrera Raphael V, Fletcher Paul J, Duchene David A, Thurmon Kerri L, Neff Donald A, Molina Wilson R
Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, Mailstop 3016, USA.
School of Medicine, University of Kansas Medical Center, Kansas City, KS, Mailstop 1049, USA.
World J Urol. 2021 Sep;39(9):3587-3591. doi: 10.1007/s00345-021-03593-w. Epub 2021 Jan 29.
Basketing plays an important role during flexible ureteroscopy, but it can be time-consuming, especially when fragments are too large to pass through the ureteral access sheath. We aim to present the optimal on-screen, endoscopic stone size that predicts successful basketing through various access sheaths.
A tipless basket, individually extended to 5 mm from multiple ureteroscopes: (Flex-Xc, Karl Storz; Flex-X2s, Karl Storz; LithoVue, Boston Scientific; or URF-P6R, Olympus) and via differently sized access sheaths (10-12 Fr through 13-15 Fr), was used in retrieval attempts of various artificial stone sizes (2 mm through 5 mm). A relative endoscopic stone size was recorded as the stone's maximum diameter on endoscopic view compared to the total image diameter.
Basketing of stones up to 2.5 mm, yielding relative endoscopic stone sizes of 0.38 (Flex-Xc), 0.30 (Flex-X2s), 0.32 (LithoVue), and 0.34 (URF-P6R), was successful using all access sheaths. Only the 12-14 Fr and greater sheaths allowed for successful basketing of 3 mm stones. Larger stones did not successfully pass through any of the access sheaths.
Successful stone retrieval can be predicted by estimating the stone's size on screen, which is influenced by the type of flexible ureteroscope and access sheath. In our testing, stones of approximately one-third of the screen size passed successfully in all cases.
套石篮在输尿管软镜检查过程中起着重要作用，但可能耗时较长，尤其是当结石碎片过大无法通过输尿管通路鞘时。我们旨在提出通过各种通路鞘成功套石的最佳内镜下结石大小预测指标。
使用无尖端套石篮，分别从多种输尿管软镜（Flex-Xc，卡尔史托斯；Flex-X2s，卡尔史托斯；LithoVue，波士顿科学；或URF-P6R，奥林巴斯）伸出至5毫米，并通过不同尺寸的通路鞘（10-12F至13-15F），对各种人工结石大小（2毫米至5毫米）进行取石尝试。相对内镜下结石大小记录为内镜视野中结石的最大直径与整个图像直径的比值。
使用所有通路鞘，套取最大直径达2.5毫米的结石均成功，相对内镜下结石大小分别为0.38（Flex-Xc）、0.30（Flex-X2s）、0.32（LithoVue）和0.34（URF-P6R）。只有12-14F及更大尺寸的鞘能成功套取3毫米的结石。更大的结石无法成功通过任何通路鞘。
通过估计屏幕上结石的大小可预测取石是否成功，这受输尿管软镜类型和通路鞘的影响。在我们的测试中，屏幕大小约三分之一的结石在所有情况下均成功通过。
