Absorption of irrigating fluid during percutaneous transrenal lithotripsy

Area of Science:

• Urology
• Nephrology
• Medical Engineering

Background:

• Percutaneous lithotripsy is a common procedure for kidney stone removal.
• Mannitol solution is frequently used as an irrigating fluid during this procedure.
• Understanding irrigating fluid absorption is crucial for patient safety.

Purpose of the Study:

• To quantify the intraoperative absorption of isotonic mannitol solution during percutaneous lithotripsy.
• To identify potential risk factors or warning signs associated with significant fluid absorption.

Main Methods:

• Study included 28 patients undergoing percutaneous lithotripsy with mannitol irrigation.
• Intraoperative fluid absorption was estimated by measuring postoperative plasma and urinary mannitol concentrations.
• Operating times and intraoperative bleeding were recorded.

Main Results:

• Most patients experienced minor fluid absorption.
• Six patients had fluid absorption exceeding 100 ml.
• Two patients showed significant absorption, with calculated values of 1220 ml and 1860 ml.
• Intraoperative bleeding was observed as a warning sign in cases of high fluid absorption.

Conclusions:

• While generally safe, percutaneous lithotripsy with mannitol irrigation can lead to significant fluid absorption in a subset of patients.
• Intraoperative bleeding serves as a critical indicator of excessive irrigating fluid absorption.
• Monitoring fluid absorption and recognizing bleeding are essential for safe percutaneous lithotripsy procedures.