Do Changes Occur in Hemodynamic Parameters, Hemogram, Renal Function and Serum Electrolytes during Percutaneous Nephrolithotomy? Its Correlation with Irrigation Fluid and Intravenous Fluid
Introduction: Percutaneous nephrolithotomy (PCNL) is a standard minimally invasive urological procedure for the treatment of large renal calculi. It is also associated with complications arising from absorption of irrigation fluid and intravenous fluid injection. We evaluated the changes occurring in vital and blood parameters during PCNL using 0.9% normal saline (NS) as an irrigation fluid. Materials and Methods: We prospectively studied 71 patients who underwent PCNL in our hospital between 2016 and 2018. NS (0.9%) was used as irrigation fluid in all patients. Changes in hemodynamics, hemogram, renal function tests and serum electrolytes were noted and assessed for significance using paired t-test. These changes were correlated with ASA grade, BMI, total operating time, total irrigation fluid used and total intravenous fluid used using Pearson’s correlation test. Results: A significant fall in serum creatinine was present (1.30 ± 0.96 vs. 1.24 ± 0.93) along with a rise in eGFR (85.39 ± 24.10 vs. 90.18 ± 22.58). A significant rise in serum potassium (4.34 ± 0.45 vs. 4.5 ± 0.56) and chloride levels (104.79 ± 3.51 vs. 106.69 ± 3.14) post-operatively was noted. A significant rise in pulse rate (80.84 ± 10.13 vs. 87.76 ± 13.12) and systolic blood pressure (127.67 ± 15.90 vs. 136.88 ± 19.56) post-operatively was noted. There was no significant change noted in hemoglobin, PCV, platelets and serum sodium levels. Total operating time and irrigation fluid volume showed a positive correlation with changes in eGFR, serum chloride, post-operative pulse rate and blood pressure values. Intravenous fluids volume correlated positively with changes in serum potassium, chloride, post-operative pulse rate and blood pressure values. Conclusion: High amount of irrigation fluid absorption can cause early post-operative changes in patients’ hemodynamics and blood indices. Overzealous hydration during PCNL with potassium containing fluids can also lead to hyperkalemia and hyperchloremic acidosis. Thus, early post-operative monitoring of serum electrolytes should be done in all patients after PCNL to prevent complications arising from dyselectrolytemia.
References
[1]
Lang, E.K. (1987) Percutaneous Nephrostolithotomy and Lithotripsy: A Multi-Institutional Survey of Complications. Radiology, 162, 25-30. https://doi.org/10.1148/radiology.162.1.3786771
[2]
Gehring, H., Nahm, W., Zimmermann, K., Fornara, P., Ocklitz, E. and Schmucker, P. (1999) Irrigating Fluid Absorption during Percutaneous Nephrolithotripsy. Acta Anaesthesiol Scand, 43, 316-321. https://doi.org/10.1034/j.1399-6576.1999.430312.x
[3]
Xu, S., Shi, H., Zhu, J., et al. (2014) A Prospective Comparative Study of Haemodynamic, Electrolyte, and Metabolic Changes during Percutaneous Nephrolithotomy and Minimally Invasive Percutaneous Nephrolithotomy. World Journal of Urology, 32, 1275-1280. https://doi.org/10.1007/s00345-013-1204-2
[4]
Atici, S., Zeren, S. and Aribogan, A. (2001) Hormonal and Hemodynamic Changes during Percutaneous Nephrolithotomy. International Urology and Nephrology, 32, 311-314. https://doi.org/10.1023/A:1017527126481
[5]
Mohta, M., Bhagchandani, T., Tyagi, A., et al. (2008) Haemodynamic, Electrolyte and Metabolic Changes during Percutaneous Nephrolithotomy. International Urology and Nephrology, 40, 477-482. https://doi.org/10.1007/s11255-006-9093-6
[6]
Dipti, S., Divyangna, S., Atul, D., Saurabh, C. and Santosh, A. (2019) Effects of Fluid Absorption following Percutaneous Nephrolithotomy: Changes in Blood Cell Indices and Electrolytes. Urology Annals, 11, 163-167. https://doi.org/10.4103/UA.UA_117_18
[7]
Atici, S., Zeren, S. and Aribogan, A. (2001) Hormonal and Hemodynamic Changes during Percutaneous Nephrolithotomy. International Urology and Nephrology, 32, 311-314. https://doi.org/10.1023/A:1017527126481
[8]
Mukherjee, S., Sinha, R.K., Jindal, T., et al. (2019) Short-Term Alteration of Renal Function and Electrolytes after Percutaneous Nephrolithotomy. Urology Journal, 16, 530-535.
[9]
Rupel, E. and Brown, R. (1941) Nephroscopy with Removal of Stone Following Nephrostomy for Obstructive Calculus Anuria. Journal of Urology, 46, 177-182. https://doi.org/10.1016/S0022-5347(17)70906-8
[10]
Fernstrom, I. and Johannsson, B. (1976) Percutaneous Pyelolithotomy. A New Extraction Technique. Scandinavian Journal of Urology and Nephrology, 10, 257-259. https://doi.org/10.1080/21681805.1976.11882084
[11]
Castaneda-Zuniga, W.R., Clayman, R., Smith, A., Rusnak, B., Herrera, M. and Amplatz, K. (2002) Nephrostolithotomy: Percutaneous Techniques for Urinary Calculus Removal. Journal of Urology, 167, 849-853. https://doi.org/10.1016/S0022-5347(02)80276-2
[12]
Dean Assimos, M.D., Amy Krambeck, M.D., Nicole, L., Miller, M.D., et al. (2016) Surgical Management of Stones: AUA/Endourology Society Guideline.
[13]
Oku, S., Kadowaki, T., Uemura, T. and Nishioka, H. (1993) Early Detection of Absorption of Irrigating Fluid during Transurethral Resection of the Prostate with Alcohol Gas Detector Tube. Nippon Hinyokika Gakkai Zasshi, 84, 374-381. https://doi.org/10.5980/jpnjurol1989.84.374
[14]
Hahn, R.G. (1989) Acid Phosphatase Levels in Serum during Transurethral Prostatectomy. British Journal of Urology, 64, 500-503. https://doi.org/10.1111/j.1464-410X.1989.tb05286.x
[15]
Bender, D.A. and Coppinger, S.W. (1992) Estimation of Irrigant Absorption during Transurethral Resection of the Prostate—Assessment of Fluorescein as a Marker. Urological Research, 20, 67-69. https://doi.org/10.1007/BF00294340
[16]
Tausin, F.P. and Sans, L. (1992) Prostate Transurethral Resection Syndrome. Annales Francaises D’anesthesie et de Reanimation, 11, 168-169.
[17]
Rao, P.N. (1987) Fluid Absorption during Urological Endoscopy. British Journal of Urology, 60, 93-99. https://doi.org/10.1111/j.1464-410X.1987.tb04940.x
[18]
O’Keeffe, N.K., Mortimer, A.J., Sambrook, P.A. and Rao, P.N. (1993) Severe Sepsis Following Percutaneous or Endoscopic Procedures for Urinary Tract Stones. British Journal of Urology, 72, 277-283. https://doi.org/10.1111/j.1464-410X.1993.tb00717.x
[19]
Kukreja, R.A., Desai, M.R., Sabnis, R.B. and Patel, S.H. (2002) Fluid Absorption During Percutaneous Nephrolithotomy: Does It Matter? Journal of Endourology, 16, 221-224. https://doi.org/10.1089/089277902753752160
[20]
Aguiar, P., Pérez-Fentes, D., Garrido, M., García, C., Ruibal, Á. and Cortés, J. (2016) A Method for Estimating DMSA SPECT Renal Function for Assessing the Effect of Percutaneous Nephrolithotripsy on the Treated Pole. The Quarterly Journal of Nuclear Medicine and Molecular Imaging, 60, 154-162.
[21]
Chua, H.R., Venkatesh, B., Stachowski, E., et al. (2012) Plasma-Lyte 148 vs 0.9% Saline for Fluid Resuscitation in Diabetic Ketoacidosis. Journal of Critical Care, 27, 138-145. https://doi.org/10.1016/j.jcrc.2012.01.007
[22]
El Gkotmi, N., Kosmeri, C., Filippatos, T.D. and Elisaf, M.S. (2017) Use of Intravenous Fluids/Solutions: A Narrative Review. Current Medical Research and Opinion, 33, 459-471. https://doi.org/10.1080/03007995.2016.1261819
[23]
McCluskey, S.A., Karkouti, K., Wijeysundera, D., et al. (2013) Hyperchloremia after Noncardiac Surgery is Independently Associated with Increased Morbidity and Mortality: A Propensity-Matched Cohort Study. Anesthesia & Analgesia, 117, 412-421. https://doi.org/10.1213/ANE.0b013e318293d81e
[24]
Purkait, B., Kumar, M., Bansal, A., Sokhal, A.K., Sankhwar, S.N. and Singh, K. (2016) Is Normal Saline the Best Irrigation Fluid to Be Used during Percutaneous Nephrolithotomy in Renal Failure Patient? A Prospective Randomized Controlled trial. Turkish Journal of Urology, 42, 267-271. https://doi.org/10.5152/tud.2016.46690
[25]
Aghamir, S.M.K., Alizadeh, F., Meysamie, A., Assefi Rad, S. and Edrisi, L. (2009) Sterile Water Versus Isotonic Saline Solution as Irrigation Fluid in Percutaneous Nephrolithotomy. Urology Journal, 6, 249-253.
