TY - JOUR
T1 - Expedited struvite-stone dissolution using a high-flow low-pressure irrigation system
AU - Collins, Sean
AU - Ortiz, Jorge
AU - Maruffo, Franzo
AU - Hruby, Gregory W.
AU - Pierorazio, Phillip M.
AU - Gupta, Mantu
AU - Monga, Manoj
AU - Landman, Jaime
PY - 2007/10/1
Y1 - 2007/10/1
N2 - 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.
AB - 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.
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U2 - 10.1089/end.2007.9916
DO - 10.1089/end.2007.9916
M3 - Article
C2 - 17949316
AN - SCOPUS:35348992716
SN - 0892-7790
VL - 21
SP - 1153
EP - 1157
JO - Journal of Endourology
JF - Journal of Endourology
IS - 10
ER -