In this case, a stone was stuck in the lateral calyx of the kidney. Options for removal were nitinol basket, which was not available, flexible nephroscope, another percutaneous access to push the stone with the needle-PCNL or rigid ureteroscope. The choice ended up being the improvisation of a nitinol basket - image below.
Is it possible to make a basket with another material readily available in the operating room? Yes, the nylon suture. The following steps show how to make a nylon basket:
The improvised baskets worked in the retrieval of both rough and smooth stones. The making of this basket was easy to achieve, and they were made on the spot, so time was not an issue. The drawback might be the instability of the nylon basket, potentially increasing the number of trials to catch the stones.
Improvising a basket was achievable using both nitinol guidewire and 2/0 nylon suture with a coaxial double-J stent pusher, to use through the nephroscope. Both techniques were effective in PCNL cases.
Presented by: Mohammed Lezrek, MD, Military Hospital Moulay Ismail, Department of Urology, Meknes, Morocco
Written by: Linda My Huynh, a Senior Clinical Research Coordinator (Department of Urology, University of California-Irvine) and medical writer for UroToday.com at the 34th European Association of Urology (EAU 2019) #EAU19, conference in Barcelona, Spain, March 15-19, 2019.