1685 PERCUTANEOUS NEEDLE STICK ACCESS INTO THE KIDNEY IS ASSOCIATED WITH VASOCONSTRICTION

Abstract

You have accessJournal of UrologyStone Disease: New Technology/SWL, Ureteroscopic or Percutaneous Stone Removal1 Apr 20111685 PERCUTANEOUS NEEDLE STICK ACCESS INTO THE KIDNEY IS ASSOCIATED WITH VASOCONSTRICTION Rajash Handa, Cynthia Johnson, Ehud Gnessin, Bret Connors, Andrew Evan, and James Lingeman Rajash HandaRajash Handa Indianapolis, IN More articles by this author , Cynthia JohnsonCynthia Johnson Indianapolis, IN More articles by this author , Ehud GnessinEhud Gnessin Indianapolis, IN More articles by this author , Bret ConnorsBret Connors Indianapolis, IN More articles by this author , Andrew EvanAndrew Evan Indianapolis, IN More articles by this author , and James LingemanJames Lingeman Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1862AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The percutaneous nephrolithotomy (PCNL) procedure for removing stones from the kidney involves gaining access to the collecting system by advancing a 18-gauge needle through the skin and kidney until the needle tip enters the urinary collecting system, and then the needle access tract is expanded and stabilized so that a channel is created for the introduction of endoscopic instrumentation to remove stones. We have shown in animal models that percutaneous access procedures can acutely impair renal function, resulting in marked reductions in glomerular filtration rate (GFR) and renal plasma flow (RPF) of 50–60% (J Endourology 20:1030–40, 2006). The surgical factors contributing to the PCNL-associated reduction in renal function are unknown. Therefore, the focus of the present study was to determine if insertion of the 18-gauge needle through the skin and into the kidney initiates the decrease in renal function observed immediately after PCNL. METHODS Acute experiments were performed in seven anesthetized adult female farm pigs. GFR and RPF were assessed by the renal clearance of inulin and para-aminohippuric acid, respectively, before and immediately after needle stick access. RESULTS A single needle stick to access the pig's urinary collecting system caused significant falls in GFR and RPF of ≈22% and ≈32%, respectively, in the treated kidney. The fall in renal function was not limited to the needle-treated kidney but also occurred in the opposite untreated kidney, albeit to a lesser extent (see figure). Our previously published work has shown that there is no significant change in GFR and RPF in either kidney of sham-treated pigs (J Endourology 20:1030–40, 2006). CONCLUSIONS The simple insertion of a needle into one kidney for percutaneous access to the urinary collecting space has significant effects on bilateral renal function. This highlights that the kidney is highly sensitive to the trauma induced by needle insertion and responds with vasoconstriction in both kidneys&em;an effect that was previously not known. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e677-e678 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rajash Handa Indianapolis, IN More articles by this author Cynthia Johnson Indianapolis, IN More articles by this author Ehud Gnessin Indianapolis, IN More articles by this author Bret Connors Indianapolis, IN More articles by this author Andrew Evan Indianapolis, IN More articles by this author James Lingeman Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...