Irrigating fluid absorption during percutaneous nephrolithotripsy

Gehring, Hartmut; Nahm, W.; K, Zimmermann; Fornara, Paolo; Ocklitz, Evelyn; Schmucker, P.

doi:10.1034/j.1399-6576.1999.430312.x

Cited by 35 publications

(24 citation statements)

References 12 publications

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“…Symptoms of fluid overload depend on volume of absorption and hemodynamic status. [9] It may lead to neurological or hemodynamic instability. Vascular problems may include bradycardia, hypertension, hypotension and decreased urine output.…”

Section: Discussionmentioning

confidence: 99%

Is normal saline the best irrigation fluid to be used during percutaneous nephrolithotomy in renal failure patient? A prospective randomized controlled trial

Purkait

Kumar

Bansal

et al. 2016

Turkish Journal of Urology

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Objective: Endoscopic procedures like percutaneous nephrolithotomy (PCNL) needs continuous irrigation for better vision and to wash away stone fragments and blood clots. Systemic absorption of irrigation fluids may lead to fluid overload and electrolyte disequilibrium. Renal failure patients are more prone to these electrolyte disturbances. We have evaluated the outcomes of normal saline as irrigation solution to be used in renal failure patient in comparison to distilled water. Methods:Seventy-six patients with renal calculi were enrolled in this study between September, 2014, and December, 2015. All patients have compromised renal functions (creatinine >1.6 mg/dL). All patients were randomized into two groups as Group A (normal saline irrigation), and Group B (distilled water irrigation). Serum electrolytes, hemogram were measured pre-and post operatively. Results:The mean duration of irrigation was 53.34 min in Group A and 52.80 min in Group B (p=0.12). Serum sodium, potassium and hematocrit levels were changed significantly after the PCNL in Group B (p=0.03, 0.04 and 0.02, respectively). The most significant drop was observed in sodium level (139.21±3.65 vs. 136.20±4.10 mEq/L) in Group B. Though Hemoglobin drop was similar in both groups, there was a significant drop in hematocrit value in Group B (p=0.02). Conclusion:Distilled water is associated with hyponatremia and drop in hematocrit level in renal failure patients. Serum potassium level may be significantly altered during distilled water irrigation. Normal saline is safe for PNCL in renal failure patient and its use should be recommended for this purpose.

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Section: Discussionmentioning

confidence: 99%

Is normal saline the best irrigation fluid to be used during percutaneous nephrolithotomy in renal failure patient? A prospective randomized controlled trial

Purkait

Kumar

Bansal

et al. 2016

Turkish Journal of Urology

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“…[9][10][11] However, some studies have reported hyponatremia and hypokalemia and explained these changes by renal tubular dysfunction due to mechanical irritation of kidneys and glycine 1.5% induced hyponatremia during PCNL. 2,[12][13][14] In our study, we compared the change in the two clinically most important electrolytes -sodium (Na) and potassium (K). Difference in serum sodium levels of both the groups was statistically non-significant at all the stages of procedure.…”

Section: Side Effectsmentioning

confidence: 99%

Comparative study of electrolytes and metabolic changes during percutaneous nephrolithotomy: spinal vs. general anaesthesia

Gupta

Prakash

Singh³

et al. 2014

Int J Clin Trials

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“…Percutaneous nephrolithotripsy (PCNL) is a common technique to treat kidney stones and is also used to fragment and remove the calyx and pelvic stones (1)(2)(3)(4)(5). Nowadays to manage large stones, stones resistant to fragmentation, or stones with an abnormal anatomy in kidney, PCNL is preferred (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…There was no rolled tower on the flank and no change in leg position in csPCNL. This endoscopic technique (csPCNL)which needs continuous irrigation can result in serious complications (5). One of the most important complications is extravasationof large amount of irrigation fluid to retroperitonealspace that increases the likelihood of septic complications (9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

“…In some studies electrolytic changes due to PCNL, showed hyponatremia and metabolic acidosis other than hypertension (3,13). To avoid complications due to absorption of fluid without electrolytes, normal saline is the fluid which is commonly used for irrigation (3,5). Manipulation under X-Ray or endoscopy, by continuous open flowing systemcan also be usedto prevent electrolytic imbalance.…”

Section: Introductionmentioning

confidence: 99%

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6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

Khoshrang¹,

Falahatkar²,

Naseh³

et al. 2010

European Urology Supplements

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Background: Nowadays Percutaneous Nephrolithotomy (PCNL) is performed in prone and supine positions. Physiologic solutions should be used to irrigate during PCNL. Irrigation can cause hemodynamic, electrolyte and acid-base changes during PCNL. Objectives: The current study aimed to compare the electrolyte, hemodynamic and metabolic changes of prone and complete supine PCNL. Patients and Methods: It was a randomized clinical trial study on 40 ASA class I and II patients. Twenty of patients underwent prone PCNL (Group A) and the other twenty underwent complete supine PCNL (Group B). The two groups received the same premedication and induction of anesthesia. Blood pressure (systolic, diastolic and mean) and pulse rate were recorded before, during and after anesthesia and Hb, Hct, BUN, Cr, Na, and K were also measured before and after operation in the two groups. The volume of irrigation fluid, total effluent fluid (the fluid in the bucket and the gazes) and volume of absorbed fluid were measured. Results: There were no significant differences in Na, K, BUN, Cr, Hb and Hct between the two groups. Absorption volume was significantly different between the two groups (335 ± 121.28 mL in group A and 159.45 ± 73.81 mL in group B, respectively) (P = 0.0001). The mean anesthesia time was significantly different between the two groups (P = 0.012). There was a significant difference in bleeding volume between supine and prone PCNL (270.4 ± 229.14 in group A and 594.2 ± 290 in group B, respectively) (P = 0.0001). Mean systolic blood pressure during operation and recovery was 120.2 ± 10.9 and 140.7 ± 25.1 in group B, and 113.4 ± 6.4 and 126.2 ± 12.7 in group A, respectively. Systolic blood pressure between the two groups during operation and recovery was significantly different (P = 0.027 and P = 0.022, respectively). Mean diastolic blood pressure in supine group during operation and recovery was 80.53 ± 7.57 and 95.75 ± 17.48, and 73.95 ± 3.94 and 83.4 ± 12.54 in prone group, respectively. Diastolic blood pressure was significantly different between the two groups. It was 80.55 ± 7.57 and 95.75 ± 17.48, respectively during operation and recoveryin the supine group and 73.95 ± 3.94 and 83.4 ± 12.54 in the prone group, respectively (P = 0.001 and P = 0.014, respectively), but there was no significant difference between the pulse rate mean value of the two groups. Conclusions: The electrolyte and metabolic changes were not significantly different between the two groups, and although fluid absorption in prone group was more than that of the complete supine group, there was no significant difference between the two groups. Considering advantages of complete supine PCNL such as less hemodynamic changes (less hypotension, less fluid absorption and less duration of operation) this kind of PCNL was recommended.

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Irrigating fluid absorption during percutaneous nephrolithotripsy

Abstract: Retroperitoneal extravasation can be identified by using ethanol monitoring during and after PNL. Afflicted patients require considerably longer hospitalisation, probably because of the additional injury to surrounding organ structures.

Cited by 35 publications

References 12 publications

Is normal saline the best irrigation fluid to be used during percutaneous nephrolithotomy in renal failure patient? A prospective randomized controlled trial

Is normal saline the best irrigation fluid to be used during percutaneous nephrolithotomy in renal failure patient? A prospective randomized controlled trial

Comparative study of electrolytes and metabolic changes during percutaneous nephrolithotomy: spinal vs. general anaesthesia

6 Comparative Study of Hemodynamics Electrolyte and Metabolic Changes During Prone and Complete Supine Percutaneous Nephrolithotomy

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