1985 Volume 76 Issue 9 Pages 1336-1340
The present study was performed to examine whether irrigant solution is absorbed to the systemic circulation by percutaneous ultrasonic nephrolithotripsy (PUN) enough to cause any significant changes of serum electrolytes or hematocrit level. Using 2.7% D-sorbitol-0.54% D-mannitol or 3% D-sorbitol solution as irrigant, serum electrolytes, osmolarity and hematocrit were measured before and immediately after PUN in 10 patients with renal stones. The osmolarity gap, which is the difference between the measured osmolarity after PUN and that calculated from the formula {2Na+1/3 BUN+1/18 glucose}, was thought to be a useful indicator to estimate the amount of irrigant fluid absorption. The irrigant bag was placed 100cm above the level of the kidney, while the fluid in the renal pelvis was constantly aspirated by the equipped peristaltic pump. The intrapelvic pressure, thus, was maintained between 40 and 60cmH2O.
After PUN, there was a slight, insignificant decrease in serum sodium concentration. The hematocrit level, however, decreased significantly (p<0.05) and this decrease correlated well with the amount of irrigant fluid used in PUN. The measured osmolarity gap after PUN averaged 10.4±7.4mOsm/L (mean±S.D.). The amount of irrigant absorption, which was estimated from the osmolarity gap, ranged from 300 to 800ml under the particular irrigation method mentioned above. There was, however, no single patient who complained of any clinical symptoms caused by water intoxication, and the postoperative convalescence was uneventful in all the patients.
From these observations, it is concluded that PUN is a safe procedure and the amount of fluid absorption during this procedure is within acceptable range, if the intrapelvic pressure is kept below 60cmH2O.
