Lidocaine Jell Instillation During Ureteroscopic Stone Fragmentation Effectively Reduces Stone Migration

Abstract

Introduction: Inadvertent migration of stone during ureteroscopy is a relatively common problem. In this video we are describing a cost-effective technique for prevention of inadvertent stone pushback during ureteroscopy. The current study and our previous work1 studied the efficacy of Lidocaine jelly instillation proximal to the ureteral stone during intracorporeal lithotripsy using a semi rigid ureteroscope for the prevention of retrograde migration and improvement in stone-free rate. The video is on MPEG format and the run time is 10 min. Materials and Methods: The technique described involved Lidocaine jelly instillation proximal to the stone before fragmentation. The jell is instilled either by using an open end ureteral catheter bypassing the stone under Ureteroscopic guidance or by bypassing the stone with the ureteroscope and instilling jell via the working channel of the ureteroscope. The ureteroscopy was performed using an 8F, 7F, or 6.4F semi rigid ureteroscope. A 5F ureteral stent was advanced beyond the stone. Lidocaine jelly (2 mL) was instilled and lithotripsy was performed with a Swiss LithoClast™. Alternatively, fragmentation can also be performed using a holmium laser. After the procedure, either a 5F ureteral catheter was left in place for 24 h or an indwelling Double-J stent is left in place for 2–4 weeks. Patients were followed at 24 h 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: Instillation of jell before laser or pneumatic fragmentation of ureteral stone is associated with significant reduction in inadvertent stone migration during ureteroscopy. Use of jell is not associated with any side effects. However, during fragmentation using pneumatic lithotripsy devise and laser, there is some masking of the devise built in fragmentation sound. In addition, there is some clouding that can affect vision. This deficiency can be effectively countered by liberal use of irrigation, as with jell in place the chances of migration even with liberal irrigation are insignificant. Conclusions: Lidocaine jelly instillation proximal to ureteral calculi during lithotripsy using either pneumatic device or laser is an effective method of preventing retrograde stone displacement as well as significantly improving the stone-free rate. No competing financial interests exist. Runtime of video: 9 mins 59 secs