When Is the Indication of Percutaneous Chemolysis Justified?

Abstract

Persistent residual stone fragments after extracorporeal Shockwave lithotripsy (ESWL), percutaneous nephrolitholapaxy (PNL) as well as pyelo- and nephrolithotomy represent a great problem in the treatment of stones. The choice of therapy for patients with insufficient renal drainage, poor renal function, and a high anesthetic risk also remains quite difficult. Between 1991 and 1993, 5 patients underwent percutaneous antegrading chemolysis with ‘Suby G’ solution. Two patients, presenting struvite and apatite stones, were free of stones afterwards. In 1 patient, where stone analysis revealed a predominant brushite component, a large decrease in stone size could be observed. In 2 other cases, with stones mainly consisting of whewellite and weddelite, chemolysis proved ineffective. Evaluating our own clinical experience and relevant medical literature, the present study goes on to prove that the indication of percutaneous chemolysis in risk patients as described above is dependent on stone analysis, and must be regarded as an effective adjuvant treatment.

Chemolitholysis and Lithotripsy of Infectious Urinary Stones – An in vitro Study

“…We prefer the use of Suby G solution because clinically renacidin shows a clearly higher rate of toxicity [2]. Our results confirm that the solubility of struvite and apatite stones is pH-dependent and increases with falling pH value ( fig.…”

“…Looking at the dilution of Suby G solution with artificial urine (2:1; 1:2) it is shown that it is the concentration of free citric acid and not the pH (increases only slightly from 3.6 over 3.9 to 4.1) playing the major role in the dissolution process of infectious urinary stones. Our own clinical experience [2] and a detailed analysis of the literature clearly demonstrate the high efficacy of local chemolysis. However, a number of conditions have to be maintained (i.e.…”

“…In these cases a stone-free rate can be obtained up to 100% [2]. Furthermore, it is possible to treat patients with insufficient renal drainage (such as paraplegics), malfunction of kidneys or high narcotic risk by primary local dissolution with a stone-free rate again up to 100% [2].…”

Influence of Alkaline Solutions on Chemolitholysis and Lithotripsy of Uric Acid Stones

“…Our investigations show that THAM (pH 10) is most effective regarding chemolysis of uric acid calculi and shows an 11–fold stronger ability to dissolve uric acid calculi than artificial urine. Using this solution with a dissolution speed of 80 ml/h, a 10–mm fragment can be expected to be dissolved in approximately 14 h. Our own clinical experience [4]and a detailed analysis of the literature clearly demonstrate the high efficacy of percutaneous chemolysis. However, a number of conditions has to be maintained (i.e.…”

“…In these selected cases dissolution of uric acid calculi may be achieved by local irrigation with alkaline substances. Furthermore, in the presence of a percutaneous nephrostomy inserted because of primary ureteral obstruction by uric acid stones, percutaneous nephrolithotomy (PNL), open stone removal or because of secondary ureteral obstruction due to uric acid stone fragments after shock wave lithotripsy (SWL), PNL or open procedures it is also possible to carry out chemolysis by local application of an alkaline solution [4]. …”