RENAL-STONE DISSOLUTION VIA PERCUTANEOUS NEPHROSTOMY

Recurrent renal stones associated with urinary infection were treated in eight kidneys in six patients by percutaneous nephrostomy and irrigation with hemiacidrin, a commercially available solution of organic acids and magnesium. The stones, presumably composed of triple phosphates (magnesium, ammonium and calcium phosphate), were completely dissolved in six kidneys; in two they were partially dissolved and subsequently recovered by other methods. No serious complications were encountered. The technic requires special precautions against perinephric and intravascular dissemination of infection, but it offers potentially effective therapy for certain kidney stones without the use of general anesthesia or operation. (N Engl J Med 300:341–343, 1979) TREATMENT of renal calyceal and pelvic calculi by dissolution has been attempted for decades.1 2 3 4 5 6 7 A number of solutions8 9 10 11 and catheter arrangements12,13 have been tried, but despite sporadic reports of successfully dissolved stones, treatment by irrigation remains a little used technic. One reason has been the difficulty of providing and maintaining adequate lavage. Retrograde catheterization is limited by the size of the ureter, and small ureteral catheters are frequently occluded by fragments of stone. Surgical nephrostomy requires the same general anesthesia and surgical exposure of the kidney as a nephrolithotomy and therefore offers no real advantage over surgical stone extraction. The. © 1979, Massachusetts Medical Society. All rights reserved.