Lidocaine Jelly Prevents Ureteral Stone Displacement

Lidocaine jelly can be used to prevent retrograde stone displacement during pneumatic lithotripsy for ureteral calculi, according to a new study.

Researchers at the Tehran University of Medical Sciences (Iran) conducted a trial involving 34 patients with upper ureteral calculi less than 2 cm in size. The patients were randomized into two groups: 16 received jelly instillation and 18 served as controls. Ureteroscopy was performed using a 9.8 French semi-rigid ureteroscope and lithotripsy was performed with a Swiss lithoclast. In the instillation group, a 5F ureteral stent was advanced beyond the stone and 2 ml of lidocaine jelly was instilled prior to the lithotripsy. A 5F ureteral catheter was left in place and patients were followed up at 24 hours with radiography of the kidneys, ureters, and bladder (KUB) and at 2 weeks with intravenous urography (IVU).

In both groups, the stone was merely fragmented into small pieces, and no baskets were used to retrieve stone particles and remove them. At the conclusion of the procedure in the treatment group, the ureter was lavaged with normal saline to break up the lubricating jelly. Analysis of the results showed that stone or stone fragment migration occurred in 12.4% of the treatment group and 44.4% of the controls. The stone-free rate was 93.7% and 83.3% in the treatment and control groups, respectively. The study was published in the September 2006 issue of Urology.

"Lidocaine jelly instillation proximal to the ureteral calculi during lithotripsy is an effective method to prevent retrograde stone displacement, but its effect on improving the stone-free rate was not significant in our study. Larger studies are needed to disclose more details about the efficacy of this method,” concluded Dr. M. G. Mohseni, M.D., and colleagues of the department of Urology.



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Tehran University of Medical Sciences