Abstract

Use of Lidocaine Jelly for Prevention of Inadvertent Retrograde Stone Migration during Pneumatic Lithotripsy of Ureteral Stone

The success of URS depends on various factors including stone size, location degree of proximal hydronephrosis, and energy source used. Various techniques are used to minimize stone retropulsion but the majority of them are expensive. This study aims to study the efficacy of lidocaine jelly instillation proximal to ureteral stone during a semi-rigid ureteroscope for the prevention of retrograde migration and improvement in stone-free rate. Method: 100 patients with 5 mm to 14 mm ureteral stones undergoing ureteroscopic removal using pneumatic lithotripsy were randomized into 2 groups. Group 1 (50 patients) had lidocaine jelly instilled proximal to the stone before fragmentation, and group 2 was the control group (50 patients). A 5Fr ureteral stent was advanced beyond the stone over the guidewire. Lidocaine jelly (2 ml) was instilled and all patients underwent ureteroscopy under spinal anesthesia with a 7Fr semirigid ureteroscope and a 4Fr working channel. Pneumatic lithotripsy was done. Results: Upward stone or fragment migration to the kidney occurred in 2 patients (4%) in the treatment group and 14 patients (28%) in the control group, which was a statistically significant difference (p=0.002). Although the mean operative time was slightly longer in the treatment group (36.56 ± 7 vs. 35.84 ± 12.5 minutes) the difference was not significant (p=0.450) Conclusions: Instillation of 2% lidocaine jelly just proximal to the stone in the ureter before starting ureteroscopic guided fragmentation of the stone using a pneumatic lithotripsy device is a simple and inexpensive option that can significantly reduce inadvertent stone migration and result in a higher stone-free rate.

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