Gómez-Núñez Joel Gustavo, Alvarez Ulises M, Fernández Francisco, Aceves Jorge Gutiérrez, Loske Achim M
Instituto de Endourología, Hospital Puerta de Hierro, Zapopan, México.
J Endourol. 2009 Mar;23(3):519-22. doi: 10.1089/end.2008.0264.
Renal calculi may contain bacteria that can remain active inside the stone and produce bacteremia and/or endotoxemia after lithotripsy. Urinary tract infection associated with urinary stones represents high morbidity. The purpose of this research was to use novel artificial struvite stones inoculated with living bacteria and to study the effect of four different intracorporeal lithotripters on bacterial inactivation after in vitro lithotripsy.
Two types of artificial kidney stone models (calcium sulphate and mixed struvite-calcium sulphate) were manufactured and infected with Proteus mirabilis. Stones were fractured using either electrohydraulic, laser, ultrasonic, or pneumatic lithotripters. Bacterial viability was determined before and after the lithotripsy.
Bacterial inactivation was not affected by the stone matrix; ie, calcium or struvite. The four tested lithotripters were almost equally efficient at reducing the viability of P mirabilis in both the low and the high energy setting.
We were able to obtain novel artificial struvite stones infected with bacteria. Intracorporeal lithotripters are efficient at reducing the viability of P mirabilis in vitro. Tested stone materials play a minor role regarding inactivation. Whether the bactericidal effect reported is desirable or not is still to be answered, because the presence of endotoxin from cell lysis may increase the risk of urosepsis.
肾结石可能含有细菌，这些细菌在结石内部可保持活性，并在碎石术后导致菌血症和/或内毒素血症。与尿路结石相关的尿路感染发病率很高。本研究的目的是使用接种活细菌的新型人工鸟粪石结石，并研究四种不同的体内碎石机在体外碎石术后对细菌灭活的影响。
制作了两种人工肾结石模型（硫酸钙和鸟粪石 - 硫酸钙混合模型），并感染奇异变形杆菌。使用液电、激光、超声或气压碎石机对结石进行破碎。在碎石术前和术后测定细菌活力。
细菌灭活不受结石基质（即钙或鸟粪石）的影响。在低能量和高能量设置下，四种测试的碎石机在降低奇异变形杆菌活力方面几乎同样有效。
我们成功获得了感染细菌的新型人工鸟粪石结石。体内碎石机在体外能有效降低奇异变形杆菌的活力。测试的结石材料在灭活方面作用较小。所报道的杀菌效果是否理想仍有待解答，因为细胞裂解产生的内毒素可能会增加尿脓毒症的风险。
