Objective: We studied the efficacy and safety of lubricating jelly instillation before ureterolithotripsy for prevention of retropulsion and improvement in stone-free rate. Material & methods: We enrolled 22 subjects with ureteral stone in this prospective, randomized, single-blind and controlled clinical trial. Each subject was randomly assigned to the lubricating jelly instillation group (n=11) and control group (n=11). Ureteroscopy and lithotripsy was performed according the standard protocol, using 9.8 F semirigid ureteroscope and pneumatic lithotripter. A 6 F ureteral catheter was advanced beyond the stone, and lubricating jelly was instilled through the catheter lumen. Retropulsion and the presence of residual fragments were evaluated with plain kidneys, ureters and bladder x-ray and ultrasonography, or Non Contrast-enhanced Computed Tomography. Any complication was reported and graded using the Modified Clavien Classification System.Results: The 2 groups had comparable preoperative characteristics. There were no statistically significant difference between the lubricating jelly instillation group and control group regarding the retropulsion rate (54.5% vs 72.7%, ρ=0.375), the stone-free rate (54.5% vs 36.4%, ρ=0.392), and the complication rate (45.5% vs 54.5%, ρ=0.670). Conclusion: Lubricating jelly instillation during ureterolithotripsy has limited value for prevention of retropulsion and improvement in stone-free rate.
Ureterolithotripsy, retropulsion, lubricating jelly instillation
Matlaga BR, Lingeman JE. Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (editors). Campbell-Walsh Urology, 10th ed. Philadelphia: Saunders Elsevier; 2012. p. 1375–407.
Papadouakis S, Stolzenburg J, Truss MC. Treatment strategies of ureteral stones. EAU-EBU Update Series 4; 2006. p. 184–90.
Preminger GM, Tiselius H, Assimos DG, Alken P, Buck C, Gallucci M, et al. Guideline for the management of ureteral calculi. J Urol. 2007; 178: 2418–34.
Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS. Management of ureteral calculi: A cost comparison and decision making analysis. J Urol. 2002; 167: 1621–9.
Schuster TG, Hollenbeck BK, Faerber GJ, Wolf Jr JS. Complications of ureteroscopy: Analysis of predictive factors. J Urol. 2001; 166: 538–40.
Rane A, Bradoo A, Rao P, Shivde S, Elhilali M, Anidjar M, et al. The use of a novel reverse thermosensitive polymer to prevent ureteral stone retropulsion during intracorporeal lithotripsy: A randomized, controlled trial. J Urol. 2010; 183: 1417–23.
Rane A, Sur R, Chew B. Retropulsion during intracorporeal lithotripsy: What’s out there to help? BJU Int. 2010; 106: 591–4.
Ursiny M, Eisner BH. Cost-effectiveness of anti-retropulsion devices for ureteroscopic lithotripsy. J Urol; 2013. p. 1762–6.
Ali AA, Ali ZA, Halstead JC, Yousaf MW, Ewah P. A novel method to prevent retrograde displacement of ureteric calculi during intracorporeal lithotripsy. BJU Int. 2004; 94: 441–2.
Mohseni MG, Arasteh S, Alizadeh E. Preventing retrograde stone displacement during pneumatic lithotripsy for ureteral calculi using lidocaine jelly. Urology. 2006; 68: 505–7.
Zehri AA, Ather MH, Siddiqui KM, Sulaiman MN. A randomized clinical trial of lidocaine jelly for prevention of inadvertent retrograde stone migration during pneumatic lithotripsy of ureteral stone. J Urol. 2008; 180: 966–8.
Mitropoulos D, Artibani W, Grafen M, Remzi M, Roupret M, Truss MC. Guidelines on reporting and grading of complications after urological surgical procedures. European Association of Urology; 2013. p. 6–13.
Mandal S, Goel A, Singh MK, Kathpalia R, Nagathan DS, Sankhwar SN, et al. Clavien classification of semirigid ureteroscopy complications: A prospective study. Urology. 2012; 80: 995–1001.
Bastawisy M, Gameel T, Radwan M, Ramadan A, Alkathiri M, Omar A. A comparison of stone cone vs lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy. Ther Adv Urol. 2011; 3(5): 203–10.
El-Nahas AR, El-Tabey NA, Eraky I, Shoma AM, El-Hefnawy AS, El-Assmy AM, et al. Semirigid ureteroscopy for ureteral stones: A multivariate analysis of unfavorable results. J Urol. 2009; 181: 1158–62.