The Zeiss-loop stone extraction: minimal invasive and effective or obsolete?

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Treatment

Background:

• The advent of ureterorenoscopy (URS) and extracorporeal shock wave lithotripsy (ESWL) has diminished the role of traditional methods like the Zeiss-loop for ureteral stone removal.
• Current expert opinion guidelines suggest against stone extraction without endoscopic visualization, impacting the perceived value of older techniques.

Purpose of the Study:

• To evaluate the current position and efficacy of the Zeiss-loop procedure in ureteral stone treatment in the era of URS and ESWL.
• To assess the success rates and complications associated with Zeiss-loop extraction for ureteral stones.

Main Methods:

• Retrospective analysis of 253 patients treated with the Zeiss-loop for ureteral stones.
• All Zeiss-loop extractions were performed under radiological control, with the loop fully withdrawn.

Main Results:

• Complete stone removal was achieved in 219 out of 253 patients (96.5%).
• The Zeiss-loop was most effective for distal ureteral stones (221 cases), with a high success rate for stones up to 10 mm.
• Complication rates were low, with no instances of complete ureteral tear-off. Success rates for loop extraction were superior to ESWL but inferior to URS, though comparable for smaller distal stones.

Conclusions:

• The Zeiss-loop, under fluoroscopic control, is a feasible alternative for treating small distal ureteral stones (<10 mm).
• Despite its historical reputation, the Zeiss-loop can maintain a role in endoscopic stone management, particularly in specific clinical scenarios.