title: A randomized clinical trial of lidocaine jelly for prevention of inadvertent retrograde stone migration during pneumatic lithotripsy of ureteral stone.
abstract: OBJECTIVE
  We studied the efficacy of lidocaine jelly instillation proximal to the ureteral stone during intracorporeal lithotripsy using a semirigid ureteroscope for the prevention of retrograde migration and improvement in stone-free rate.
  
  
  METHODS
  From November 2006 to September 2007, 50 patients with 5 to 18 mm ureteral stones undergoing ureteroscopic removal using pneumatic lithotripsy were randomized into 2 groups. Group 1 (25 patients) had lidocaine jelly instilled proximal to the stone before and after fragmentation, and group 2 was the control group (25 patients). Ureteroscopy was performed using an 8 or 6.4Fr semirigid ureteroscope. A 5Fr ureteral stent was advanced beyond the stone. Lidocaine jelly (2 ml) was instilled and lithotripsy was performed with a Swiss LithoClast . A 5Fr ureteral catheter was left in place for 24 hours. Patients were followed at 24 hours with plain x-ray of the kidneys, ureters and bladder, and at 2 weeks with noncontrast enhanced computerized tomography of the kidneys, ureters and bladder.
  
  
  RESULTS
  The 2 groups were comparable with regard to age and stone size. Stone or stone fragment migration occurred in 4% and 28% of patients in groups 1 and 2, respectively, and this difference was statistically significant (p = 0.002). At 2 weeks followup with imaging the stone-free rate was 96% and 72% in groups 1 and 2, respectively, and this difference was also statistically significant (p = 0.045). Although the mean operative time was slightly longer in the treatment group (33.56 +/- 13 vs 35.84 +/- 12.5 minutes) the difference was not significant (p = 0.450).
  
  
  CONCLUSIONS
  Lidocaine jelly instillation proximal to ureteral calculi during lithotripsy is an effective method of preventing retrograde stone displacement as well as significantly improving the stone-free rate.
authors.affiliation: Department of Surgery, The Aga Khan University, Karachi, Sind, Pakistan.
authors.forename: Ali A
authors.initials: AA
authors.lastname: Zehri
authors.forename: M Hammad
authors.initials: MH
authors.lastname: Ather
authors.forename: Khurram M
authors.initials: KM
authors.lastname: Siddiqui
authors.forename: M Nasir
authors.initials: MN
authors.lastname: Sulaiman
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D004304:Dosage Forms; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage / Q000627:therapeutic use*; D008096:Lithotripsy / Q000295:instrumentation*; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000150:complications* / Q000628:therapy*; D018666:Ureteroscopy
chemical_list: D000779:Anesthetics, Local; D004304:Dosage Forms; D008012:Lidocaine