Effects of Various Acidic and Alkaline Solutions Used to Dissolve Urinary Calculi on the Rabbit Urothelium

Dönmez, T.; Erol, Kevser; Gürer, Fi̇rdevs; Bayçu, Cengiz; Açikalin, E.; Cingi, M. I.

doi:10.1159/000281723

Cited by 9 publications

(2 citation statements)

References 10 publications

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“…In particular, in the treatment of kidney stones through chemical dissolution many chemical solutions, either Ph dependent or chelating agents, can damage the urothelial tissue [ 7 ]. In a rabbit model, Zhang et al demonstrated that calcium dissolving agents can cause histological alterations of the bladder mucosa that include edema, urothelial cell damage and neutrophil infiltration [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Bladder irrigation and urothelium disruption: a reminder apropos of a case of fatal fluid absorption

et al. 2014

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BackgroundIrrigation or washouts of the bladder are usually performed in various clinical settings. In the 1980s Elliot and colleagues argued that urothelial damage could occur after washouts and irrigations of the bladder. The exact mechanism underlying urothelial damage has not yet been discovered. To our knowledge, this is the first report of fatal fluid overload and pulmonary edema, due to urothelium disruption occurring during bladder irrigation, approached performing complete histological and immunohistochemical investigation on bladder specimens. The exposed case deserves attention since it demonstrates that, although very rarely, irrigation or washouts of the bladder may have unexpected serious clinical consequences.Case presentationAn 85 year-old Caucasian man, unable to eat independently and whose fluid intake was controlled, underwent continuous bladder irrigation with a 3-way catheter due to a severe episode of macrohematuria. During the third day of hospitalization, while still undergoing bladder irrigation, he suddenly experienced extreme shortness of breath, breathing difficulties, and cough with frothy sputum. His attending nurse immediately noted that there was no return of the fluid (5 liters) introduced through bladder irrigation. He was treated urgently with hemodialysis. At the beginning of the dialysis treatment, the patient had gained 7.4 kg since the previous measurement (24 hours prior) without any clear explanation. Although a significant weight loss (from 81 to 76 kg) due to the dialysis procedure, the patient died shortly after the final treatment. The autopsy revealed that the brain and the lungs were heavily edematous. Microscopic examination of bladder specimens revealed interstitial and mucosal swelling, and loss of the superficial cell layer. Intermediate and basal urothelial cells were preserved. Altogether the abovementioned findings were suggestive of a diffuse disruption of the urothelium. In conclusion the death of the man was attributed to an acute severe pulmonary edema due to massive fluid absorption.ConclusionOur case demonstrates that urothelium disruption may occur during irrigation and washouts of the bladder, also in the absence of other well-known predisposing conditions. Inappropriate use of bladder irrigation should be avoided and a close attention is required of the fluid balance is mandatory when irrigating the bladder.

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Section: Discussionmentioning

confidence: 99%

Bladder irrigation and urothelium disruption: a reminder apropos of a case of fatal fluid absorption

et al. 2014

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“…However, a catheter lumen holds <4 mL and it is unlikely that >50 mL are required to ®ll the catheter lumen and to cover the tip and balloon inside the bladder. The use of a larger volume than necessary means that more of the bladder tissue will be in contact with a potentially irritant chemical which could cause tissue damage [8,9]. It is conceivable that the small volume of solution within the lumen of the catheter becomes saturated with struvite and calcium phosphates relatively quickly, and that 50 mL of washout solution may be as effective at dissolving encrustations as 100 mL.…”

Section: Introductionmentioning

confidence: 99%

The dissolution of urinary catheter encrustation

Getliffe¹,

Hughes

Claire

2000

BJU International

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Objectives To identify the optimum volume of acidic bladder washout solution to dissolve catheter encrustations and to compare the effectiveness of different bladder washout delivery devices. Materials and methods Urinary catheter encrustation was generated in vitro using a model of the catheterized bladder adapted from previous work. An acidic bladder washout solution (Suby G) was applied via the catheter in the model and retained for 15 min. The amount of encrusting material dissolved was measured by colorimetric analysis of the magnesium and calcium content of the solution returned after the washout procedure. The relative effectiveness of different volumes of washout solution and different washout delivery devices (Optiflow, Bard Ltd, Crawley; UroTainer, B/Braun Medical Ltd, Aylesbury; and a bladder syringe) in dissolving catheter encrustations was compared to the ‘standardized’ conditions commonly used in practice. Results There was no statistically significant difference between washouts with 100 mL and washouts with 50 mL for any of the delivery devices tested. Gentle agitation with 50 mL Suby G did not significantly improve the dissolution of encrustation but the total amount of material dissolved when two washouts with 50 mL Suby G were used sequentially was significantly better than a single washout with either 100 mL or 50 mL. Conclusions Under controlled laboratory conditions, smaller volumes of acidic bladder washout solution (50 mL) are as effective as the 100 mL commonly used in practice, but two sequential washouts with 50 mL are more effective than a single washout. The newly designed Optiflow delivery device is at least as effective as the other devices tested. This study provides new evidence which may contribute to decision‐making by practitioners in relation to cath‐eter care.

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A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02%

Kelly,

Glinsky,

Harvey

2024

Spinal Cord Ser Cases

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Introduction Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment. Case presentation These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms. Discussion Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm. This case report was prepared following the CARE Guidelines (supplementary file 1).

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Effects of Various Acidic and Alkaline Solutions Used to Dissolve Urinary Calculi on the Rabbit Urothelium

Cited by 9 publications

References 10 publications

Bladder irrigation and urothelium disruption: a reminder apropos of a case of fatal fluid absorption

Bladder irrigation and urothelium disruption: a reminder apropos of a case of fatal fluid absorption

The dissolution of urinary catheter encrustation

A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02%

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