A randomized clinical trial of lidocaine jelly for prevention of inadvertent retrograde stone migration during pneumatic lithotripsy of ureteral stone.
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.
Zehri
Ali A
AA
Department of Surgery, The Aga Khan University, Karachi, Sind, Pakistan.
Ather
M Hammad
MH
Siddiqui
Khurram M
KM
Sulaiman
M Nasir
MN
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
D000779:Anesthetics, Local; D004304:Dosage Forms; D008012:Lidocaine