Ureteroscopic management of lower-pole renal calculi: Technique of calculus displacement

Purpose: We review our technique of ureteroscopic management of lower pole renal calculi with Nitinol basket displacement and holmium laser stone frag mentation. Methods: Lower pole calculi are identified with a 7.5F flexible ureteroscop e. In patients in whom the laser fiber reduces ureteroscopic deflection, pr ecluding reentry into the lower pole, a Nitinol basket or grasper is used t o displace the calculi into an upper pole calix for easier fragmentation. Results: The Nitinol device can be passed into the lower pole through the f ully deflected ureteroscope without any loss of deflection. Irrigation is s ignificantly reduced by the basket, but this factor does not impede stone r etrieval. Conclusions: Ureteroscopic management of lower pole stones is a reasonable alternative to SWL or percutaneous nephrolithotomy in low-volume stone dise ase. If the stone cannot be fragmented in situ, Nitinol basket capture thro ugh a fully deflected ureteroscope into a less dependent position facilitat es stone fragmentation.