Comparison of small diameter stone baskets in an in vitro caliceal and ureteral model

Background and Purpose: Three small diameter (<1.5F) stone baskets have recently been introduced. Our objective was to evaluate the stone capture rate of these baskets in an in vitro ureteral model and an in vitro caliceal model using novice, resident, and expert operators. Materials and Methods: Sacred Heart Medical Halo™ (1.5F), Cook N-Circle® Nitinol Tipless Stone Extractor (1.5F), and Boston Scientific OptiFlex® (1.3F) stone baskets were tested in an in vitro ureteral and a caliceal model by three novices, three residents, and three experts. The caliceal model consisted of a 7-cm length of 10-mm O.D. plastic tubing with a convex base. Each operator was timed during removal of a 3-mm calculus from each model with three repetitions for each basket. Data were analyzed by analysis of variance single factor tests and t tests assuming unequal variances. Results: In the ureteral model, the Halo had the fastest average rate of stone extraction for experts and novices (0:02±0:01 and 0:08±0:04 min, respectively), as well as the overall fastest average stone extraction rate (0:08±0:06 min). No statistical significant differences in extraction times between baskets were identified in the resident group. In the novice group, the Halo stone extraction rate was significantly faster than the OptiFlex (P=0.029). In the expert group, the OptiFlex had statistically significant slower average extraction rates compared with the Halo (P=0.005) and the N-Circle (P=0.017). In the caliceal model, no statistically significant differences were noted. Conclusion: While no significant differences were noted in extraction times for the caliceal model, the extraction times for the ureteral model were slowest with the OptiFlex basket. Other variables important in selection of the appropriate basket include operator preference, clinical setting, and cost.