Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2 cm

Abstract

PurposeIrrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the absorbed fluid volumes during percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for stones larger than 2 cm.Materials and methodsGeneral anesthesia was applied to all patients. Isotonic solution containing 1 % ethanol was used as irrigation fluid. Venous blood ethanol concentration was first measured with the start of irrigation and thereafter every 15 min until the patients left the recovery room. Absorbed fluid volumes were measured using the blood ethanol concentrations. Duration of irrigation, irrigated fluid volume, stone size and grade of hydronephrosis were also recorded.ResultsA total of 60 patients were included the study. Fluid absorption occurred in all patients. Minimum and maximum ranges of fluid absorption were 20–573 mL for RIRS and 13–364 mL for PCNL. The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group. Also prolongation of operation led to a significant increase in absorption in the PCNL group. Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes.ConclusionBoth RIRS and PCNL are conducted under high pressure and can be accompanied potential complications such as SIRS. The fluid absorption confirmed in our study should be taken into consideration during RIRS and PCNL.

Effects of fluid absorption following percutaneous nephrolithotomy: Changes in blood cell indices and electrolytes

“…[5] and recently by Guzelburc et al . [11] However, our study also shows that the height of irrigating fluid and total time for irrigation do not show any correlation with the above-mentioned indices. Height of irrigating fluid is an important determinant of fluid absorption during the TURP.…”

Advances in Lasers for the Treatment of Stones—a Systematic Review

“…The most frequent complication in laser lithotripsy is fever [ 102 ]. Renal backflow and infected urine fluid reabsorption can be one of the causes, and curiously retrograde intrarenal surgery (RIRS) has higher total fluid absorption than percutaneous nephrolithotomy (PCNL) procedures [ 103 ], which makes sense considering the enclosed space in RIRS. The presence of a preoperative stent, obstructive pyelonephritis, a positive preoperative bladder urine culture result, female gender, increased stone size, or lengthy operating time are significantly associated with postoperative fever and risk of sepsis [ 104 , 105 ].…”

Visual clarity of irrigants used during flexible ureterorenoscopy: an in vitro comparison

“…They performed a volumetric fluid balance and concluded that routine URS is associated with minimal systemic fluid absorption and sterile water for URS is safe even if ureteral perforation occurs. Conversely, in a prospective study which ethanol 1% was used as irrigant, it has been showed that absorbed fluid during RIRS was not negligible [ 17 ]. Zeltser et al stated in their commentary that even though sterile water has better visuality, isotonic saline should be the irrigant of choice in ureterorenoscopic procedures since sterile water may cause serious complications including cardiovascular collapse, in accordance to their personal observations [ 18 ].…”