Expedited struvite-stone dissolution using a high-flow low-pressure irrigation system

Sean Collins, Jorge Ortiz, Franzo Maruffo, Gregory W. Hruby, Phillip M. Pierorazio, Mantu Gupta, Manoj Monga, Jaime Landman

Research output: Contribution to journalArticle

Abstract

Background and Purpose: The clinical application of chemolysis for struvite stones is limited because of the need for a nephrostomy tube and the potential risk of elevated intrarenal pressures, which may be associated with sepsis and metabolic derangements. We evaluated the utility of a high-flow low-pressure irrigation system, designed to minimize the disadvantages of chemolysis, for struvite-stone dissolution. Materials and Methods: An in-vitro urinary-tract model was used to compare a novel dual-lumen ureteral catheter with a standard nephrostomy tube for struvite stone chemolysis. A laboratory-proved large human struvite stone was divided into 3.5-g fragments, which were placed in the model. In the experimental group, Renacidin® (citric acid, glucono-Δ-lactone, and magnesium carbonate; Guardian Laboratories, Lake Forest, IL) irrigation was performed through the high-flow low-pressure irrigation system. In the control group, Renacidin solution was infused at 120 mL/hour through a nephrostomy tube. Three stones were tested in each group. Intrarenal pressures, irrigant-flow rates, chemolysis rates at each time interval, overall chemolysis rates, and changes in chemolysis rates over time were compared using ANOVA. Results: The mean intrarenal pressure with the high-flow low-pressure irrigation system and the nephrostomy tube were 5.3 and 7.5 cm H2O, respectively (P < 0.001). The overall chemolysis rates with the high-flow low-pressure irrigation and control systems were 0.12 g/hr and 0.06 g/hr, respectively (P = 0.025). The chemolysis rates in the experimental and control groups did not differ significantly with time (P = 0.75 and 0.21, respectively). Conclusions: In this in-vitro model, the high-flow low-pressure irrigation system facilitated struvite-stone chemolysis by achieving significantly higher flow rates than a traditional percutaneous system. Additionally, the system yielded lower intrarenal pressures than standard nephrostomy-tube irrigation.

Original languageEnglish (US)
Pages (from-to)1153-1157
Number of pages5
JournalJournal of Endourology
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

ASJC Scopus subject areas

  • Urology

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    Collins, S., Ortiz, J., Maruffo, F., Hruby, G. W., Pierorazio, P. M., Gupta, M., Monga, M., & Landman, J. (2007). Expedited struvite-stone dissolution using a high-flow low-pressure irrigation system. Journal of Endourology, 21(10), 1153-1157. https://doi.org/10.1089/end.2007.9916