|
|
CASE REPORT |
|
|
|
| Year : 2004 | Volume
: 20
| Issue : 2 | Page : 68-69 |
| |
Basketing the Basket
P Vijayan
St. Philomena's Hospital, Banglore, India
Correspondence Address:
P Vijayan
St. Philomena's Hospital, Banglore
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Vijayan P. Basketing the Basket. Indian J Urol 2004;20:68-9 |
 Case Report | |  |
A 32-year-old male was admitted with Rt. loin pain of 3 days duration associated with vomiting. Plain X-ray and ultrasound studies showed a radio-opaque calculus 7-mm in diameter in the right lower ureter with proximal dilataion of the collecting system. There was also an incidental finding of a calculus 10X8 mm in the lower calyx (Lt.Kidney) As symptoms did not subside with medications even after 2 days he was subjected to Dormia basket extraction of the stone under spinal anaesthesia.
A Dormia stone basket with filiform tip was used. Fluoroscopy was not used. The closed basket was advanced easily upto 10 cm, opened and the stone engaged. During extraction through the Rt. ureteric orifice the wires with the engaged stone were clearly visible. The basket got impacted at the ureteric meatus and hence a limited meatotomy was performed using the stylet of a ureteric catheter (5F) as an electrode. The stylet accidentally got in contact with the wires of the basket. The wires melted and snapped, as a result, the filiform tip, the distal part of the wires and the stone retracted into the lumen of the lower ureter, disappearing from view. As an ureteroscope was not readily available, the procedure was abandoned. The mishap was explained to the patient. He was asked to report in 3 weeks time or earlier if there were symptoms. He went home the following day.
He turned up 14 months later with mild lower urinary symptoms. He had passed 2 stones per urethram few months earlier without any difficulty. A new X- ray film showed the retained portion of the basket in situ [Figure - 1]
On 30/6/2001 under spinal anaesthesia ureteroscopic extraction of the retained stone basket was planned. Before doing so, a blind basketting was attempted. The stone basket went in easily; when opened, engaged the retained portion of the basket and extraction was uneventful [Figure - 1]
However the lower ureteric stone (Rt) and the Lt. renal stone were conspicuously absent. Ultrasound study showed no evidence of obstruction.
The patient was discharged home the next day. 2-year follow-up study showed no symptoms, or recurrence of stone disease. Sonography revealed no abnormality of the urinary tract.
| Comments | | |
Dormia Basket like other stone extractors has been in use for many years until ureteroscopy came on the scene. It is recommended to be used under fluoroscopic guidance or as an accessory in ureteroscopy. The basket has also been employed for extraction of bil iary stone [1] ascaris worms from the bile duct, broken ureteric stents [2] foreign bodies in ureter [3] and salivary ductal stone. Complications following basket extraction of ureteric stone include perforation of ureteric wall, avulsion of the ureter, ureteric mucosal injuries, fracture of the wires, delayed development of distal ureteric stricture and impaction of the basket with the stone at the ureteric meatus. The last complication is managed by either slow traction over a period of 48 hours or by a limited meatotomy either by diathermy using the metal stylet of ureteric catheter, or by visual urethrotome knife.
The above case is interesting in that basketting the (retained part of) basket was successful in spite of a lapse of nearly 14 months. To my knowledge this is the first case of such a procedure ending successfully.
| References | | |
| 1. | Sauter G, Sackmann M, Holl J,et al.- Dormia Baskets impacted in the bile duct: release by extracorporeal shock-wave lithotripsy: Endoscopy (1995):27: 384-7  |
| 2. | Erkan I, Sariyuce.0 and Ozen.H- Retrieval of broken double -J catheter by Dormia basket: British Journal of Urology (1990):66:1: 107-108 |
| 3. | Grossman, I.,Pollacle,H.M.,Banner, M.P.,et al.Endoscopic removal of foreign body using Dormia stone basket: Urology, (1982) XX, 458-460 |
[Figure - 1], [Figure - 2]
|
