1973 Volume 64 Issue 11 Pages 879-897
There were 151 patients of staghorn calculi in our department from 1955 to 1971. Sixty-four cases underwent nephrolithotomy. After April 1968, the continuous pelvic irrigation method was performed on 17 patients after the nephrolithotomy of staghorn calculi. The technique of this irrigation is shown in Fig. 1. The solution used for the irrigation was normal saline 1, 000ml-2, 000ml containing Cephalothin (abbreviation: CET) 1.0g-2.0g per day. The purpose of this procedure is to prevent post-operative complications, such as renal infection, secondary hemorrhage, persistant urinary fistula, secondary nephrectomy, etc.
Of 47 cases without the continuous pelvic irrigation after nephrolithotomy from January 1955 to March 1968, 2 cases of secondary hemorrhage, 7 cases of persistant urinary fistula and 1 case of secondary nephrectomy were observed. But no post-operative complications were seen in 17 cases with the continuous pelvic irrigation after operation.
To evaluate the clinical effects of this method, the following studies were carried out. Continuous pelvic irrigation with normal saline containing CET or Gentamicin (abbreviation: GM) was performed for 24 hours on the left kidney of dogs with bilateral ureterostomy. The urinary recovery of antibiotics from the right kidney, the serum level, the concentration of drugs in the bilatenal renal tissue after irrigation and histological influences on both kidneys were examined.
In group I (normal kidney, CET 1.0g), urinary recovery rate of CET was 0.12% of dosage administered. In group II (experimental Proteus mirabilis pyelonephritic kidney, CET 1.0g), urinary recovery rate was 0.59% of that, which was about 5 times as much as group I. In group III (normal kidney, CET 10.0g) and IV (normal kidney, GM 1.0g), urinary recovery rate was more than that of group I and less than group II. The serum levels of drugs at the end of the irrigation ranged between 0.54mcg/ml and 1.1mcg/ml and the concentration of drugs in the renal tissue at the same time was determined as between 0.36mcg/g and 2.9mcg/g in group III and IV.
Histological examinations of specimens from the irrigated kidneys showed that the moderate degenerative changes of epithelium of tubules were observed in cases of group III (CET 10.0g) and IV (GM 1.0g), but these pathological changes were not observed in the irrigated kidneys in cases of group V (irrigation with normal saline). It may be possible that these changes of tubular epithelium were caused by the pharmaco-dynamic influence of applied antibiotics, the excessive pressure and speed of irrigation or the osmotic pressure of solution.
Nephrotomy with or without the continuous pelvic irrigation was performed on the experimental Proteus mirabilis pyelonephritic kidney in dogs, and the courses of these cases were followed up and examined histologically. Group A: the continuous pelvic irrigations with the normal saline containing CET 1.0g per 1, 000ml were done for 24 hours after the nephrotomy of experimental pyelonephritic kidney. In this group, histological examinations of operated kidneys revealed that pyelitis and the wounds of tissues were apparently improved. Group B: the continuous irrigations with normal saline without antibiotics were done for 24 hours after the operation. In this group, histological examinations revealed that pyelitis was improved, but the wound was less recovered than in group A. In these two groups, post-operative specimens showed that the pre-existing infection did not spread into the parenchyma after the operation. Group C: nephrotomies without the continuous pelvic irrigation were carried out. Histological examination revealed that both pyelitis and inflammation in the renal parenchyma were worsened.
