| BackgroundUrinary infection with urea splitting organisms creates alkaline urine that promotes the formation of struvite stones, which are constituted by ammonium magnesium phosphate and calcium carbonate. The disease is easy to cause hydronephrosis and renal parenchyma demolish, resulting in renal inadequacy. At present, patients with struvite stones are usually treated by PCNL. However, postoperative problems like high temperature, septic shock and high recurrence rate of renal struvite stones remain troublesome. Therefore, we try to explore a kind of irrigating solution to clean up local infection and dissolve the small residual stones after operation by local litholytic irrigation.ObjectiveTo solve the problem that the struvite stone patients who have high temperature, septic shock and high recurrence rate after PCNL. We try to explore a kind of irrigating solution to clean up local infection and dissolve the small residual stones after operation, then use it in the clinic.Methods1. The pus substances got from the patient's pyonephrosis were analyzed by fourier transform infrared (FTIR) spectroscopy to know the main chemical group.2. The litholysis and pus substance dissolving experiments were carried out t in vitro to determine the constituents of irrigating solution initially.3. The uroepithelium tissue pathological injure caused by the irrigating solution was determined with the use of microscope and immunohistochemistry methods after the rabbit bladders were irrigated by the renal irrigating solutions. Results1. The roughly composition of the pus substances was a commixture of proteins and mineral matters.2. The pus substances in Group A remained undissolved after 48 hours. The time of half dissolving (t1/2 ) in Group D was the fastest compared with the other groups(P<0.01). No significant difference of the t1/2 among Groups B, C, E and F was observed(P>0.05), but the t1/2 in Group C and Group F were shorter than those in Group B and GroupE.3. A total of 24 rabbits were selected and were irrigated with 0.9â„…Sodium Chloride +ceftriaxone sodium (Group A), Suby's G solution+ceftriaxone sodium (Group B), Suby's G solution+5000u/ml urokinase+ceftriaxone sodium (Group C) or Suby's G solution+10000u/ml urokinase+ceftriaxone sodium (GroupD). Half of the rats were respectively sacrificed at the time of either 24 hours or one week after the irrigation, with the bladders harvested for pathology examinations. With the light microscopy examination, injure of the uroepithelium tissue caused by the 3 irrigating solutions was significantly more serious compared with the saline group (P<0.05), but no difference was observed between the injure caused by the 3 irrigating solutions (P>0.05). The immunohistochemistry method showed that the expression levels of TNF-a and IL-8 in Group B, C and D were significantly higher than Group A (p<0.01). Group B and C showed significant slighter injure at the time of 24h after the irrigation (p<0.01), while no significant difference was observed between Group B, C and D at the time of 1W after the irrigation (p>0.05).Conclusions(1)The renal pus substances may be a commixture of died cells, proteins and mineral matters. (2) The renal pus substances can be dissolved by the irrigating solution of Suby's G solution+5000u/ml urokinase+ceftriaxone sodium in vitro. (3) The comolex irrigating solution we selected doesn't cause great injure of urothelial tissue, and the injure can turn better one week later, which shows that injure is reversible and the solution is safe and effective.
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