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REFERENCES

1. Ellik M: Stones in the ureter: their extraction by loopedatheter. J Urol 57: 473–478, 1947.

2. Chow GK, Patterson DE, Blute ML, et al: Ureteroscopy:ffect of technology and technique on clinical practice. J Urol70: 99–102, 2003.3. Segura JW, Preminger GM, Assimos DG, et al: Ureteral

tones Clinical Guidelines Panel summary report on the man-gement of ureteral calculi. J Urol 158: 1915–1921, 1997.

4. El-Gabry EA, and Bagley DH: Retrieval capabilities ofifferent stone basket designs in vitro. J Endourol 13: 305–07, 1999.5. Ptashnyk T, Cueva-Martinez A, Michel M, et al: Compar-

tive investigations of the retrieval capabilities of various bas-ets in four ex vivo models. Eur Urol 41: 406–410, 2002.6. Dormia E: Dormia basket: standard technique, observa-

ions and general concepts. Urology 20: 437, 1982.7. Hendlin K, Lee C, Anderson JK, Monga M: Evaluation of

tone basket configurations. J Endourol 17(suppl): 2003.

EDITORIAL COMMENTThe authors compared six tipless and four helical stone

askets using an inanimate ureteral model. The investigators’ain aim was to compare the rapidity of stone capture with

ach device when used by six experienced individuals. Al-hough they did not show a statistically significant differenceetween the two groups, the authors found the Cook N-Circle.0F basket had the fastest overall time to extraction and waseemed the most efficient.The findings and conclusions from this research require

onsideration of several important points. As the fidelity ofnanimate simulators improves, their use will increase, notnly to learn technical skills, but also to evaluate new instru-ents. To make sense of observations seen using simulatedodels, however, it is important to know whether the simu-

ator has undergone rigorous validation studies and is trulyepresentative of the human organ being replicated. Only thenan we translate the findings of such studies to clinicallyeaningful conclusions.As the authors state, numerous factors can be considered

hen evaluating stone baskets. Factors such as cost, the effectsf the basket on irrigant flow, endoscope deflection, ease ofse, and the potential for ureteral trauma are important con-

38

iderations. We would contend one of the most importanteatures of any basket should be the ease at disengaging thetone. Although nothing replaces good clinical judgment,ost causes of ureteral trauma with basket use occur when the

tone and basket become lodged and the stone cannot be re-eased. Clearly, surgeon experience imparts an essential vari-ble that cannot be overlooked.

We would contend these factors may be equally, if notore, important than the speed of stone entrapment. It is open

o question whether the finding of a 7.1-second differenceetween stone retrieval with the fastest and slowest basket islinically important, particularly if the other factors listedbove were not accounted for.

Andrew Tan, M.D.Division of Endourology

Hassan Razvi, M.D.Division of Urology

University of Western OntarioLondon, Ontario, Canada

doi:10.1016/j.urology.2004.04.064© 2004 ELSEVIER INC.

ALL RIGHTS RESERVED

REPLY BY THE AUTHORSThe relative importance of the ability of a stone basket to

apture versus release a stone is open to debate and is relatedo the frequency with which the endoscopist “misjudges” theize of the stone to be removed. If it is a frequent occurrencehat the stone is too large and must be released, we couldoncur that the ease of release is an important feature. How-ver, if with experience, the ability to judge the size of thetone correctly improves, ease of capture becomes more criti-al. The inability to capture a stone fragment expeditiouslyay lead to frustration, and frustration during an endoscopic

rocedure can lead to disaster.Manoj Monga

doi:10.1016/j.urology.2004.04.065

UROLOGY 64 (3), 2004