The Evaluation of the Result of Warm Normal Saline Irrigation in Ureteral Endoscopic Surgeries: A Randomized Clinical Trial

Mohammad Ali Mohammadzadeh Rezaei, Alireza Akhavan Rezayat, Mahmoud Tavakoli, Lida Jarahi



Purpose: Transurethral lithotripsy (TUL) is a major modality for the endoscopic management of ureteral stones.
Ureteral spasm makes access for ureters difficult, which causes impaction of the ureteroscope, ureteral dislodge,
and a low success rate of endoscopic surgeries. This study described the outcomes of a new endoscopic surgical
experience by use of 40-degree warm saline irrigation during TUL compaired with routine ambient air irrigation
in TUL.
Materials and methods: In this randomized clinical trial from 2014 to 2015, 150 patients with ureteral stone with
balanced randomization were divided into two parallel groups. Patients underwent TUL in the first group with
20–25 degree saline irrigation and in the second group with 40-degree saline irrigation. One surgical team with the
same semi-rigid instrument performed all TULs and the other steps were similar in both groups. Complete stone
fragmentation was measured as the primary outcome and the duration of procedure, retrograde stone migration and
all and any intraoperative complications were the secondary measurements.
Result: While comparing warm saline irrigation with cold saline irrigation, the rate of access to upper ureter was
95% versus 72%, stone retropulsion frequency was 10.7% versus 30.7% and the stone-free rate was 96% versus
76% respectively (P < .05). There was no ureteroscope impaction and ureteral dislodge in both groups.
Conclusion: Using warm saline irrigation in endoscopic surgeries results in better surgical outcomes including
a lower ureteral spasm rate, greater ureteral muscle relaxation and better access to the upper ureteral zone, and a
lower rate of complications, such as ureteroscope impaction, ureteral dislodge and stone retropulsion.

Full Text:




Geavlete P, Georgescu D, Nita G, et al. Complications of 2735 retrograde semirigid ureteroscopy procedures: a single-center experience. J endourol. 2006;20:179-85.

Singal RK, Denstedt JD. Contemporary management of ureteral stones. Urol Clin North Am. 1997;24:59-70.

Sun L, Peng FL. Simultaneous saline irrigation during retrograde rigid ureteroscopic lasertripsy for the prevention of proximal calculus migration. Can Urol Assoc J. 2013;7:E65-8.

Chow G, Blute M, Patterson D, et al.Ureteroscopy: update on current practice and long term complications. J Urol. 2001;165:71.

Delvecchio FC, Kuo RL, Preminger GM. Clinical efficacy of combined lithoclast and lithovac stone removal during ureteroscopy. J Urol. 2000;164:40-2.

Hendlin K, Weiland D, Monga M. Impact of irrigation systems on stone migration. . J endourol. 2008;22:453-8.

Knispel H, Klän R, Heicappell R, et al. Pneumatic lithotripsy applied through deflected working channel of miniureteroscope: results in 143 patients. . J endourol. 1998;12:513-5.

Sun Y, Wang L, Liao G, et al. Pneumatic lithotripsy versus laser lithotripsy in the endoscopic treatment of ureteral calculi. J endourol. 2001;15:587-90.

Bastawisy M, Gameel T, Radwan M, et al. A comparison of Stone Cone versus lidocaine jelly in the prevention of ureteral stone migration during ureteroscopic lithotripsy. Ther Adv Urol. 2011;3:203-10.

Ambani SN, Faerber GJ, Roberts WW, et al. Ureteral Stents for Impassable Ureteroscopy. J endourol. 2013;27:549-53.

Bourdoumis A, Tanabalan C, Goyal A, et al. The difficult ureter: stent and come back or balloon dilate and proceed with ureteroscopy? What does the evidence say? Urology. 2014;83:1.

Elashry OM, Tawfik AM. Preventing stone retropulsion during intracorporeal lithotripsy. Nat Rev Urol. 2012;9:691-8.

Fan B, Yang D, Wang J, et al. Can tamsulosin facilitate expulsion of ureteral stones? A meta‐analysis of randomized controlled trials. Int J Urol. 2013;20:818-30.

John TT, Razdan S. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Urology. 2010;75:1040-2.

Grasso M, Beaghler M, Loisides P. The case for primary endoscopic management of upper urinary tract calculi: II. Cost and outcome assessment of 112 primary ureteral calculi. Urology. 1995;45:372-6.

Lee H, Ryan RT, Teichman JM, et al. Stone retropulsion during holmium:YAG lithotripsy. J Urol. 2003;169:881-5.

Basiri A, Simforoosh N. Trans Ureteral Lithotripsy. Medical Journal of The Islamic Republic of Iran (MJIRI). 1990;4:247-52.

Tanagho E, McAninch J. Smith's General Urology, Seventeenth Edition: Mcgraw-hill; 2007.

Yagisawa T, Kobayashi C, Ishikawa N, et al. Benefits of ureteroscopic pneumatic lithotripsy for the treatment of impacted ureteral stones. J endourol. 2001;15:697-9.

Church JM. Warm water irrigation for dealing with spasm during colonoscopy: simple, inexpensive, and effective. Gastrointestinal endoscopy. 2002;56:672-4.


Creative Commons License 
This work is licensed under a Creative Commons Attribution 3.0 License