Comparison of absorbed irrigation fluid volumes during retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of kidney stones larger than 2cm.

Vahit Guzelburc,Mukaddes Colakogullari,Pelin Karaaslan,Selami Albayrak,Ahmet Ozturk,Selcuk Guven,Bulent Erkurt,Abdulkadir Kandemir,Mehmet Balasar

doi:10.1186/s40064-016-3383-y

Vahit Guzelburc, Mukaddes Colakogullari + Show 7 more

Open Access

https://doi.org/10.1186/s40064-016-3383-y

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Abstract

PurposeIrrigation-induced increase in intrarenal pressure is of concern because it may cause infection due to increased pyelovenous and pyelolymphatic absorption. This study is the first to compare prospectively the absorbed fluid volumes during percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) for stones larger than 2 cm.Materials and methodsGeneral anesthesia was applied to all patients. Isotonic solution containing 1 % ethanol was used as irrigation fluid. Venous blood ethanol concentration was first measured with the start of irrigation and thereafter every 15 min until the patients left the recovery room. Absorbed fluid volumes were measured using the blood ethanol concentrations. Duration of irrigation, irrigated fluid volume, stone size and grade of hydronephrosis were also recorded.ResultsA total of 60 patients were included the study. Fluid absorption occurred in all patients. Minimum and maximum ranges of fluid absorption were 20–573 mL for RIRS and 13–364 mL for PCNL. The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group. Also prolongation of operation led to a significant increase in absorption in the PCNL group. Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes.ConclusionBoth RIRS and PCNL are conducted under high pressure and can be accompanied potential complications such as SIRS. The fluid absorption confirmed in our study should be taken into consideration during RIRS and PCNL.

Highlights

Percutaneous nephrolithotomy (PCNL) is the most preferred technique for the surgical treatment of large kidneyGuzelburc et al SpringerPlus (2016) 5:1707 amounts of irrigation fluids during PCNL (Kukreja et al 2002)
The increase in fluid absorbed volume was observed as a result of the given amount of irrigating fluid used in the PCNL group
Increase in body mass index, stone size, and hydronephrosis did not affect fluid absorption significantly in either of the two operation techniques in correlation analyzes. Both retrograde intrarenal surgery (RIRS) and PCNL are conducted under high pressure and can be accompanied potential complications such as systemic inflammatory response syndrome (SIRS)

Summary

Introduction

Percutaneous nephrolithotomy (PCNL) is the most preferred technique for the surgical treatment of large kidney. Guzelburc et al SpringerPlus (2016) 5:1707 amounts of irrigation fluids during PCNL (Kukreja et al 2002). Factors affecting absorption with high intrarenal pressure during RIRS are not evaluated. This study is the first to compare prospectively the absorbed fluid volumes during two minimally invasive treatment modalities used for Stones larger than 2 cm. With non-contrast CT 1 month after surgery for PCNL. Imaging was not repeated before the second session in patients with known rest stones. The stone free rates of patients whose operation was terminated due to lack of any rest stones, were assessed with non-contrast CT 1 month after internal stent removal for RIRS

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