Collins Sean, Ortiz Jorge, Maruffo Franzo, Hruby Gregory W, Pierorazio Phillip M, Gupta Mantu, Monga Manoj, Landman Jaime
Department of Urology, Columbia University Medical Center, New York, New York 10032, USA.
J Endourol. 2007 Oct;21(10):1153-8. doi: 10.1089/end.2007.9916.
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.
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-Delta-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.
The mean intrarenal pressure with the high-flow low-pressure irrigation system and the nephrostomy tube were 5.3 and 7.5 cm H(2)O, 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).
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.
由于需要放置肾造瘘管以及存在肾内压力升高的潜在风险，而肾内压力升高可能与脓毒症和代谢紊乱相关，因此化学溶解法在鸟粪石结石临床应用中受到限制。我们评估了一种旨在尽量减少化学溶解法缺点的高流量低压冲洗系统对鸟粪石结石溶解的效用。
使用体外尿路模型，比较新型双腔输尿管导管与标准肾造瘘管在鸟粪石结石化学溶解方面的效果。将经实验室验证的一块大的人体鸟粪石结石分成3.5克的碎块，放入模型中。在实验组，通过高流量低压冲洗系统进行Renacidin（柠檬酸、葡萄糖酸 - δ - 内酯和碳酸镁；守护者实验室，伊利诺伊州莱克福里斯特）冲洗。在对照组，通过肾造瘘管以每小时120毫升的速度输注Renacidin溶液。每组测试三块结石。使用方差分析比较肾内压力、冲洗液流速、每个时间间隔的化学溶解速率、总体化学溶解速率以及化学溶解速率随时间的变化。
高流量低压冲洗系统和肾造瘘管的平均肾内压力分别为5.3厘米水柱和7.5厘米水柱（P < 0.001）。高流量低压冲洗系统和对照组的总体化学溶解速率分别为每小时0.12克和每小时0.06克（P = 0.025）。实验组和对照组的化学溶解速率随时间变化无显著差异（分别为P = 0.75和P = 0.21）。
在这个体外模型中，高流量低压冲洗系统通过实现比传统经皮系统显著更高的流速，促进了鸟粪石结石的化学溶解。此外，该系统产生的肾内压力低于标准肾造瘘管冲洗法。
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