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PubMed1987

Urothelial injury to the rabbit bladder from alkaline irrigants useful in the treatment of uric acid stones.

Irrigation of the urinary tract with alkaline solutions may be used appropriately in some clinical situations to dissolve uric acid stones. Since in vitro studies have suggested that tham-E (pH 10.6) is somewhat more effective than tham (pH 8.6) in promoting dissolution of uric acid, these studies were undertaken to assess the relative toxicities of these two irrigating solutions to the urothelium. Rabbit bladders were irrigated antegrade via a ureterotomy for twenty hours. Tham E produced considerably more mucosal injury than did tham (p = 0.0001). The minimal advantage in rapidity of stone dissolution offered by tham E over tham is more than offset by the considerably increased potential for toxic side effects. The results suggest tham and not tham E should be used for irrigation to dissolve uric acid stones.

Animals↗
PubMed2002

Sterile water irrigation of the distal vas deferens at vasectomy: does it accelerate clearance of sperm? A prospective randomized trial.

OBJECTIVES: To assess the effect of irrigation of the distal vas deferens with sterile water at the time of vasectomy on sperm clearance. Is it possible to accelerate clearance and avoid the problem of lingering sperm? METHODS: Two hundred men undergoing vasectomy were randomized to receive either a standard vasectomy or vasectomy plus irrigation of each vas deferens with sterile water. The interval between vasectomy and the production of two azoospermic semen samples was recorded. RESULTS: Overall, 37 patients were excluded for failing to follow the postvasectomy protocol for semen analysis, leaving 87 in the control group and 76 who received vasal irrigation. No statistically significant differences existed between the two groups with regard to the mean time to clearance (26.4 weeks, control group versus 28.6 weeks, flush group), proportion clear at 16 weeks (29% versus 21%), or proportion with lingering sperm at 40 weeks (22% versus 26%). CONCLUSIONS: Irrigation of the vas deferens with sterile water does not accelerate the clearance of spermatozoa after vasectomy. Men wishing to undergo vasectomy must be counseled about the possibility of lingering sperm.

Adult↗
PubMed2002

Comparison of intrarenal pressure and irrigant flow during percutaneous nephroscopy with an indwelling ureteral catheter, ureteral occlusion balloon, and ureteral access sheath.

OBJECTIVES: To determine the differential effects on renal pressures and irrigation flow associated with the application of different ureteral catheters during percutaneous nephrolithotomy. METHODS: Using ex vivo fresh cadaveric tissue, we established a percutaneous nephrolithotomy model. After obtaining lower pole percutaneous access, we recorded the pressure and irrigant flow measurements. Measurements were made with an empty ureter, 6F ureteral catheter, occlusion balloon catheter, and ureteral access sheaths (10/12F and 12/14F). Three 1-minute trials for each condition were recorded in each of four kidneys. RESULTS: Ureteral catheterization with both the 10/12F and the 12/14F ureteral access sheaths resulted in significantly decreased intrarenal pressures in the pressure range tested compared with an empty ureter, a ureteral catheter, or an occlusion balloon application. Total irrigant flow for the 12/14F ureteral access sheath was significantly higher than for the empty ureter, ureteral catheter, or occlusion balloon in the entire pressure range evaluated. CONCLUSIONS: In this in vitro cadaveric model, application of the ureteral access sheath during percutaneous nephrolithotomy resulted in decreased intrarenal pressures and increased irrigant flow.

Catheterization↗
PubMed1995

Effect of irrigating fluids and prostate tissue extracts on isolated cardiomyocytes.

OBJECTIVES: A higher mortality probably due to myocardial infarction has been demonstrated after transurethral resection of the prostate (TURP) compared with open prostatectomy. We used an experimental model system to study the possibility that this difference might be due to cardiotoxic effects of two events that frequently occur during TURP, namely, dissemination of electrolyte-free irrigating fluid and release of prostate tissue substances by electrocutting. METHODS: Cardiomyocytes were isolated from male Sprague-Dawley rats. Cell morphology and viability were examined repeatedly during 3 hours of incubation. Control experiments were compared with 34 preparations mixed with one of five different irrigating fluids and with 28 preparations mixed with a prostate extract, either from the same rat or from patients undergoing TURP. RESULTS: Most irrigating fluids reduced the viability of the myocytes. The fraction of viable cells in the incubation mixture averaged 83% (glycine 1.5%), 88% (glycine 1.5% plus ethanol 1%), 92% (glycine 2.2%), 92% (mannitol 3% plus ethanol 1%), and 99% (sorbitol 2% plus mannitol 1%) of that found in the respective control incubations. In contrast, the prostate extracts did not decrease the viability of the cardiomyocytes. Extract from the rats even seemed to have a trophic effect. CONCLUSIONS: Our results show that electrolyte-free irrigating fluids but not prostate extracts have mild cardiotoxic properties. This opens up the possibility that fluid absorption during TURP has a devitalizing effect on the heart.

Animals↗
PubMed1998

Antimicrobial activity of 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate separately and combined, as endodontic irrigants.

Sodium hypochlorite irrigant is known to be toxic to periapical tissues. Chlorhexidine gluconate, a safer and effective antimicrobial irrigant, is not known to dissolve pulpal tissues. To obtain their optimal properties, their combined action within the root canal was evaluated. Ten single rooted nonvital anterior teeth were irrigated using either 2.5% sodium hypochlorite alone, 0.2% chlorhexidine gluconate alone, 2.5% sodium hypochlorite and 0.2% chlorhexidine gluconate combined within the root canal, or 0.9% saline, respectively. Microbiological samples for culture and Gram's staining were taken before and proceeding irrigation. This study indicates that the use of sodium hypochlorite and chlorhexidine gluconate combined within the root canal resulted in the greatest percentage reduction of postirrigant positive cultures. This may be due to formation of "chlorhexidine chloride," which increases the ionizing capacity of the chlorhexidine molecule. This reduction was significant compared to use of sodium hypochlorite alone but not significant compared to use of chlorhexidine gluconate alone.

Anti-Infective Agents, Local↗
PubMed1975

Preparation of the bowel by whole-gut irrigation.

Experience with whole-gut irrigation as a method of bowel preparation in eightyone patients is described. The mean (+/-S.D.) weight-gain during irrigation was 1-9 +/- 0-8 kg; potassium losses in the effluent after one hour (4-0 +/- 2-5 g) were not significantly altered by adding potassium chloride to the irrigant. Eight irrigations were unsatisfactory, three being due to unrecognised obstructive neoplasms. The method provided excellent preparation for colonoscopy and large-bowel resection with anastomosis and was well tolerated by the patients.

Aged↗
PubMed1990

A comparison of wound irrigation solutions used in the emergency department.

The purpose of our study was to examine which of the wound irrigants commonly used in the emergency department is the most efficacious in reducing the risk of wound infection. Five hundred thirty-one patients were randomized into three groups. All patients had their wounds irrigated using a 20-mL syringe with a 20-gauge IV catheter. Patients received irrigation with normal saline (NS), 1% povidone-iodine solution (PI), or pluronic F-68 (Shur-Clens) (SC). Treatment was assigned by month; all wounds were treated with one solution during each of the three months of the study. The wounds were closed with interrupted, simple nylon sutures. The number of wound infections was 13 (6.9%), eight (4.3%), and nine (5.6%) for groups receiving NS, PI, and SC, respectively. This was not statistically significant. We conclude that there is not a significant difference in infection rates among sutured wounds irrigated with NS, PI, or SC. The cost of NS was the lowest of the three treatments in our ED.

Administration, Topical↗
PubMed1988

Effect of whole-bowel irrigation on the antidotal efficacy of oral activated charcoal.

Whole-bowel irrigation was studied in three volunteer subjects and compared with oral activated charcoal as a gastrointestinal decontamination procedure for acute drug overdose. The volunteer subjects were given 650 mg aspirin and were assigned randomly to the following treatment groups: 24-hour urine collection only; immediate whole-bowel irrigation with a polyethylene glycol solution; 50 g oral activated charcoal followed by whole-bowel irrigation; and oral activated charcoal alone. The cumulative 24-hour urinary salicylate excretion was measured in each trial. Catharsis was achieved rapidly with whole-bowel irrigation. Oral activated charcoal without catharsis was most effective in decreasing aspirin absorption (P = .011). These results do not support the routine use of a cathartic in combination with oral activated charcoal.

Adult↗
PubMed1994

Pressure dynamics of various irrigation techniques commonly used in the emergency department.

STUDY OBJECTIVE: To evaluate the pressure dynamics of common irrigation techniques used in the treatment of traumatic wounds. DESIGN: Matched experimental trial. PARTICIPANTS: Ten male volunteers. INTERVENTIONS: Pressure curves were obtained while performing manual irrigation with 250-mL boluses of normal saline with 19-gauge needles on 35-mL syringes, 19-gauge needles on 65-mL syringes, IV bags pierced with 19-gauge needles, and plastic bottles pierced with 19-gauge needles. Measurements also were obtained using an IV bag with tubing attached to either a 19-gauge or 16-gauge needle within a pressure cuff inflated to 400 mm Hg. RESULTS: Median peak pressures were 35 lb/in.2 (psi)(range, 25 to 40 psi) and 27.5 psi (range, 15 to 40 psi) using a 35-mL syringe and a 65-mL syringe, respectively. Median peak pressures with the IV bag and plastic bottle were 4 psi (range, 2 to 5.5 psi) and 2.3 psi (range, 1.2 to 4.5 psi), respectively. The IV bag in a pressure cuff generated pressures of 6 to 10 psi and 4 to 6 psi using 19-gauge and 16-gauge needles, respectively. CONCLUSION: Both 35-mL and 65-mL syringes with a 19-gauge needle are effective in performing high-pressure irrigation in the range of 25 to 35 psi. The use of IV bags and plastic bottles should be discouraged when high-pressure irrigation is required.

Adult↗
PubMed2003

Can arthrocentesis release intracapsular adhesions? Arthroscopic findings before and after irrigation under sufficient hydraulic pressure.

PURPOSE: To investigate the effect of release of intra-articular adhesions of arthrocentesis, we examined patients with closed lock of the temporomandibular joint by arthroscopy before and after irrigation. PATIENTS AND METHODS: In 6 closed lock cases in which adhesions in the upper joint space were observed by arthroscopy before arthrocentesis, arthroscopic examination was performed again to confirm whether the adhesion was released after the procedure. Range of mouth opening and joint pain were examined to determine the clinical efficiency of the procedure. RESULTS: Adhesion was not released by irrigation under low pressure but could be released by irrigation under high pressure. After irrigation under low and high pressure, the maximum mouth opening of the patients improved from 0 to 1 mm (average, 0.3 mm) and 2 to 6 mm (average, 3.7 mm), respectively. CONCLUSIONS: The results indicate that arthrocentesis with sufficient pressure could be effective for closed lock cases with adhesions in the upper joint compartment.

Adult↗
PubMed1985

Treatment of jaw cysts with an irrigational method. (II). The effect on the nature of cyst walls and surrounding bone.

Cysts in jaws are generally excised by Partsch II when they are small. When they are large, they are excised by Partsch I to form a paranasal sinus in an oral cavity, or by an operation based on Caldwell-Luc's method to form it from nostrils, as Partsch II forms dead space after the operation and the cyst increases by the pressure of intracystic fluid. However, with Partsch I, the bone needs many days to regenerate, and since a surgical ciliated cyst of the maxilla is often formed after an operation of the maxillary sinus, Partsch I is not necessarily a good method. Therefore, in order to control cyst inflammation, the irrigation of cyst cavities was repeated, as it is held that prostaglandin-like (PG-like) substances are generated in the cyst walls when a cyst is inflamed by bacterial infection; prostaglandin E2 (PGE2) especially acts on the resorption of bone and enlarges the cyst. As a result of repeated irrigations, infection of the cyst cavities disappeared simultaneously with decreasing the pressure of intracystic cavities, the values of thiobarbituric acid, Prostaglandin E, Prostaglandin F2 alpha (TBA, PGE, PGF2 alpha), and the free radical intensity at g = 2.003 decreased. The bone regenerated around the cyst walls, and finally the cyst diminished in size. In the case of the viscous cyst fluids, a solution containing hyaluronidase enabled complete disappearance. It would be better to apply Partsch II after the cyst has become smaller through irrigation. After the irrigational method, irregular formation and tendency toward malignancy could be found in none of the cyst wall cells.

Adult↗
PubMed1998

Comparison of normal saline with tap water for wound irrigation.

This study compared irrigation with tap water versus saline for removing bacteria from simple skin lacerations. The study was conducted in an animal model with a randomized, nonblinded crossover design using 10 500-g laboratory rats. Two full-thickness skin lacerations were made on each animal and inoculated with standardized concentrations of Staphylococcus aureus broth. Tissue specimens were removed before and after irrigation with 250 cc of either normal saline from a sterile syringe or water from a faucet. Bacterial counts were determined for each specimen and compared before and after irrigation. There was a mean reduction in bacterial counts of 81.6% with saline and 65.3% with tap water (P = .34). One tap water specimen had markedly aberrant bacterial counts compared with others. Excluding this specimen, the mean reduction for tap water was 80.2%. In this model, reduction in bacterial contamination of simple lacerations was not different comparing tap water with normal saline as an irrigant.

Animals↗
PubMed1988

Synovisol as an irrigant for electrosurgery of joints.

The appropriate irrigation fluid for use during arthroscopic procedures should be selected on the basis of fluid-tissue and fluid-instrumentation compatibility. This study describes a new irrigation fluid, Synovisol, that is isomolar, nonhemolytic, nonantigenic, has a low viscosity, and is nonconductive. The rabbit knee was used as a model to demonstrate the immediate and long-term (3 weeks) effects of irrigation with Synovisol compared with water, normal saline, mannitol, sorbitol, glycine, and with nonirrigated controls. Results were assessed by light- and electron-microscopic evaluation of synovium and cartilage dissected from rabbit knees. While the greatest amount of damage was seen in water-treated samples, significant effects were noted with other irrigants compared with Synovisol and controls. Long-term animals showed recovery of tissues in all cases. Systemic effects evaluated by measuring plasma glycerol levels showed a transient increase that peaked at 20 min. No hemolysis was detected and kidney morphology was normal. The physiological, electrocompatible, simplicity of formula, low cost, and long-shelf-life properties of this solution makes it a fluid uniquely suited to arthroscopy.

Animals↗
PubMed1993

[Biological changes in intra-uterine resections under glycine irrigation].

This study was carried out to assess the relations between plasma glycine concentrations and the biochemical changes occurring during intra-uterine resections (IUR) under glycine irrigation. Sixty patients with benign uterine conditions were included. They were all ranked ASA 1 or 2. The biological parameters were assessed before surgery (T0), at the end of surgery (T1) and 60 min afterwards (T2). They included the blood count and blood concentrations of sodium, potassium, chloride, proteins, bicarbonates, glucose, urea nitrogen, creatinine and glycine. Plasma osmolarity was calculated. The irrigation of the uterine cavity resulted in an increase of glycine concentrations (28% of cases), and a decrease of sodium (22% of cases), proteins and haematocrit (32% of cases). Mean osmolarity remained unchanged. Blood glycine concentrations were directly correlated with the volume of irrigating solution, as well as with the duration of surgery. Protidaemia was inversely related to the blood glycine concentration. Multiparous patients had lower glycine concentrations than nulliparous patients. This was probably due to the uterine cavity being less compliant in the latter. On the other hand, there was no correlation with the uterine pathological condition. In this series, five cases of uterine perforation occurred with very large biological variations, especially a decrease in haematocrit and osmolarity. In these cases a clinical and biological water intoxication syndrome may occur as a result of large volumes of irrigating fluid passing into the peritoneal cavity.

Adult↗
PubMed1990

Treatment of infected total knee arthroplasty. Irrigation and debridement versus two-stage reimplantation.

The results of 24 cases of deep wound infection after total knee arthroplasty were reviewed. Twenty-one knees were initially treated with irrigation and debridement. Infection recurred in 15 knees. An increased infection rate occurred after irrigation and debridement in patients in whom the index prosthesis was in place more than 2 weeks. Nine knees (including 7 that had removal after irrigation and debridement) were treated with removal of the infected prosthesis, intravenous antibiotics, and delayed reimplantation. Immediate exchange was done in one knee. There were no recurrences in this group (P less than .001). The final status of the patients included 8 with fusions or resection arthroplasties and 16 with a prosthesis. The average Hospital for Special Surgery knee rating was 41 in patients without a prosthesis and 75 in patients with a prosthesis (P less than .001). The authors conclude that irrigation and debridement is not likely to be successful for treatment of infections when used more than 2 weeks after the initial arthroplasty. Also, two-stage reimplantation for the treatment of infected total knee arthroplasties gives a reliably low recurrence rate and provides a superior clinical result, compared to arthrodesis or resection arthroplasty.

Debridement↗
PubMed2002

Effect of heparin in the irrigation solution on postoperative inflammation and cellular reaction on the intraocular lens surface.

PURPOSE: To evaluate the influence of heparin sodium in the irrigation solution on postoperative inflammation and cellular reaction on the anterior surface of a hydrophilic intraocular lens (IOL). SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This randomized prospective single-surgeon study included 50 patients with senile cataract only. Half the patients received 1 mL of heparin sodium (concentration 10 IU/mL) in addition to the regular irrigating solution. In all other respects, the procedure was standardized: clear corneal incision, phacoemulsification, and implantation of a Hydroview foldable hydrogel IOL (Bausch & Lomb). The parameters of inflammation-anterior chamber flare and cells-were evaluated with the pupil dilated in a masked fashion using a Kowa FC-1000 laser flare-cell meter 1, 3, 7, 14, and 28 days and 3, 6 and 12 months postoperatively. The cellular reaction was semiquantitatively examined and analyzed by specular microscopy. RESULTS: In both groups, flare and cell values increased on the first postoperative day and successively decreased thereafter. In the first week, the flare and cell values were significantly higher in the group without heparin sodium in the irrigating solution. Subsequently, there were no differences between the 2 groups in flare or cells. At 1 day, the heparin sodium group had statistically significantly fewer IOLs with no cells on the surface. Subsequently, no differences in cellular reaction on the IOL were observed. CONCLUSIONS: Heparin sodium added to the standard irrigating solution reduced disturbances of the blood-aqueous barrier in the early postoperative period. There seemed to be no long-term effect, especially on cellular reaction, on the hydrophilic IOL surface.

Aged↗
PubMed1994

A two-month study of the effects of oral irrigation and automatic toothbrush use in an adult orthodontic population with fixed appliances.

Forty-seven adult orthodontic patients with fixed orthodontic appliances were divided into three study groups: (1) oral irrigation with automatic toothbrush, (n = 16); (2) oral irrigation with manual toothbrushing, (n = 16); (3) control group with continued normal toothbrushing only, (n = 15). Gingival and plaque indices, bleeding after probing, and gingival sulcus depths were assessed at baseline, 1-month, and 2-month periods. Marked and significant gingival and plaque improvements from baseline were measured in all three study groups. After 1 to 2 months use of the automatic toothbrush and/or the oral irrigation device, there was a significant reduction in plaque when compared with the control group who used only the manual toothbrush (p = 0.026). Also, there was a significant reduction in gingival inflammation (p = 0.045) and evidence for reducing bleeding after probing (p = 0.037). No significant differences were found in probe depths among the three study groups, however, use of both devices reduced the pocket depth significantly from baseline by 0.5 mm (p < 0.0002). For this population of orthodontic patients, significant reductions in plaque, gingival inflammation, and a tendency for reduced bleeding after probing occurred in both groups with the power device. These improvements were most attributable to the effect of the oral irrigation device.

Adult↗
PubMed1999

Tissue necrosis after subgingival irrigation with fluoride solution.

Irrigation of periodontal pockets with fluoride solution after scaling and root planing is occasionally recommended to inhibit the growth of pathogenic bacteria in the periodontal pocket. At the same time, irrigation enables mechanical removal of loosely adhering plaque and debris. Due to its toxicity, fluoride solution deposited in the periodontium may lead to tissue damage. We report in this paper, a case of extensive periodontal tissue necrosis and permanent loss of alveolar bone after irrigation of periodontal pockets with stannous fluoride solution. The literature on the toxic effects of fluoride on the local tissues is briefly reviewed and arguments for a re-evaluation of the use of stannous fluoride for pocket irrigation are provided.

Aged↗