Intraoperative Breakage and Endoscopic Retrieval of a Dismantled Triprong Forceps During Ureterorenoscopic Lithotripsy: A Rare Complication and Review of the Literature.

Ureterorenoscopic lithotripsy (URSL) has become the gold-standard procedure for management of ureteric calculi. Ancillary stone-retrieval instruments such as triprong and biprong forceps facilitate fragment extraction; however, mechanical failure of these devices during active use is a recognized, albeit rarely documented, intraoperative hazard. We describe a 68-year-old woman who underwent left-sided URSL for a 1 cm upper ureteric calculus at the L4 vertebral level. During stone-fragment retrieval, the distal prongs of a triprong forceps sheared off within the ureter. The retained fragment was successfully retrieved endoscopically under direct vision using a biprong forceps introduced through a larger-calibre ureteroscope, obviating the need for open or laparoscopic exploration. Instrument fracture during URSL can occur due to metal fatigue from repeated sterilisation cycles, manufacturing defects, or excessive force applied to impacted calculi. Pre-procedural inspection of instruments, avoidance of instrument reuse beyond recommended cycles, complete laser fragmentation of stones before grasping, and availability of rescue instruments (biprong forceps, stone baskets, holmium laser) are paramount preventive and remedial strategies. This case adds to the sparse literature on triprong forceps failure during ureteroscopy and provides a stepwise endoscopic management algorithm for the practising urologist.