V1723: Use of a novel anti-retropulsion device for ureteroscopic treatment of ureteral stones

Video

Introduction and Objectives
Proximal migration of the stone or fragments during ureteroscopy can add time and cost to an otherwise straight-forward procedure. The Backstop® is a novel anti-retropulsion device that can be used to prevent proximal migration of stones. We report on our experience and demonstrate our technique utilizing the Backstop® during ureteroscopic treatment of ureteral calculi.

Methods
The stone is visualized within the ureter with a semi-rigid ureteroscope. The Backstop® is a liquid at room temperature and can be deployed through a 3 Fr.catheter placed through the ureteroscope. It is injected proximal to the stone under vision and forms a solid plug at body temperature. Laser lithotripsy is performed without proximal migration of the stone or any fragments produced. The Backstop® prevents migration of even the smallest stone fragments allowing for “pop-corning” of the fragments in the ureter. At the conclusion of laser lithotripsy, the Backstop® is converted back to a liquid with cold saline irrigation.

Results
The Backstop® has been used in 15 cases. There has been no proximal migration of the stone or any fragments into the renal pelvis. There has been no need to convert to flexible ureteroscopy in any of the cases. There have been no intra-operative or post-operative complications. The stone-free rate as determined by post-operative intravenous pyelogram is 100% at a median follow up of 5 months.

Conclusions
The Backstop® appears to be safe and effective at preventing proximal migration of ureteral stones and fragments during semi-rigid ureteroscopy. The advantages of the Backstop® include the ability to deploy it under vision and the ability to dissolve this plug with cold saline irrigation. There is no need for an additional wire in the distal ureter with the Backstop®, further facilitating laser lithotripsy. Routine use of the Backstop® avoids proximal stone migration, without the need for flexible ureteroscopy and therefore may lead to decreased operative times and costs.

Funding: None