TIPS & TRICKS - Stone Translocation from Lower to Upper Calyx
Translocating the Stone with a Laser Fiber
Higher ureteroscope damage risk and diminished ureteroscope movement capacity can be observed in lower calyx stones. In most cases endourologists aim to translocate the stone from the lower calyx into a middle or an upper calyx. In this way, stone disintegration is facilitated and ureteroscope damage risk (due to a bended laser fiber inside the endoscope) can be reduced.
Apart from using baskets, a practical method exists for translocation using the laser fiber. In this method, if the collecting system and the infundibulum are wide enough to accommodate the stone, the laser is activated right beside the stone using a low power setting to prevent fragmentation into bigger pieces. The laser should be touching the surface and is advanced slowly into the center of the stone. This allows the laser fiber tip to be locked inside the stone. Once the tip of the ureteroscope moves, the stone moves with it.
Due to the proximity of the stone to the endoscope tip during the translocation, this movement is performed in a “blind” fashion. Therefore, the surgeon’s instinct about where he/she is going with the stone is key. In addition, the fluoroscopic images can be obtained for further guidance.
When the stone is translocated into an upper calyx, lithotripsy can be continued without applying force and increasing the torque on the ureteroscope tip.