Preventing Migration of Stones During Fragmentation with Thermosensitive Polymer

Abstract

To define a method of stabilizing stones during extracorporeal (SWL) and intracorporeal lithotripsy with a thermosensitive polymer. Using a thermosensitive polymer that is either a liquid or a gel, depending on the temperature, both calcium oxalate and plaster of Paris phantom stones were placed in the polymer gel or saline, and SWL was performed. Comparisons were made between the effectiveness of the fragmentation in the two media. Also, in-vivo studies using the polymer to prevent migration of ureteral stones were performed in swine. Electrohydraulic lithotripsy was used on a small stone implanted in the distal ureter with the polymer instilled proximally. Once in the ureter, the polymer converted to a gel. After completion of the procedure, the polymer was restored to a liquid form by infusion of cold saline and expelled from the ureter. Three of the pigs underwent treatment of the stone, convalesced for 7 days, and then had urine collections from both ureters to compare the glomerular filtration rates, fractional sodium excretion, urine/plasma creatinine ratio, and urine/plasma urea ratio on the treated and the contralateral (control) sides. The polymer did not enhance fragmentation when used with SWL but prevented stone migration in the in-vivo studies. The physiologic parameters were not significantly different on the treated and the control sides. The polymer was easily removed from the ureter by infusing cold water. The use of this thermosensitive polymer proximal to ureteral stones prevents migration and is not traumatic to the ureter.