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WCE 2019: Anti-Retropulsion Devices, What is Available and When to Use Them

Abu Dhabi, United Arab Emirates (UroToday.com) Dr. Carlos E. Mendez-Probst presented on which anti-retropulsion devices (ARD) are available and when to use them. As an introduction to his talk, Dr. Mendez-Probst presented the scope of the problem. Retrograde stone migration is a common occurrence as it occurs in 15% of distal ureteral stones and 60% of proximal ureteral stones.  It poses challenges as it increases operating room time, the need for additional medical devices (baskets) and decreases stone-free rates. He then polled the audience to see how many were using anti-retropulsion devices currently in their practice. Only one urologist in the audience reported they used these types of devices. Globally, according to the CROES (Clinical Research Office of the Endourological Society) study by Saussine, et al. (2018) the global use of ARDs is 14.5% and they showed less stone migration (−2.0%; p = 0.050), higher stone-free rates (SFRs) (2.8%; p < 0.001), and shorter length of stay (−4.7%; p = 0.001) in the ARD group.

Dr. Mendez-Probst presented data that showed it becomes cost-effective to use an ARD at or above a 6.3% retropulsion rate. In addition to the Escape, Ntrap and Stone Cone there are alternatives including water-based jelly and coiling an angle tip guidewire such that it forms a loop on itself proximal to the stone. The Accordion utilizes braided nitinol mesh and is 12mm in diameter. Data from Dr. Mendez-Probst showed that its use reduced intraoperative stone migration length (27mm versus 46mm); however, there was no difference in stone free rate (CT at 1 month).

Dr. Mendez-Probst had several take-home messages. First, consider using an ARD when a flexible ureteroscope is not readily available. ARDs are less efficient when the proximal ureteral diameter is greater than 10mm. It is important to know the specifications of each ARD as each has its own tricks and pitfalls. Laser damage can occur to the ARD with Accordion > Stone Cone > Ntrap. In conclusion, when choosing an ARD, choose wisely as the cost may be significant.

Presented by: Carlos E. Mendez-Probst, MD, Department of Urology, National Institute of Medical Science and Nutrition, Mexico

Written by: Roshan M. Patel, MD, Department of Urology, University of California, Irvine, California at the 37th World Congress of Endourology (WCE) – October 29th-November 2nd, Abu Dhabi, United Arab Emirates