Roshan Patel, MD, on the impact of restricted irrigation on PCNL outcomes

The nationwide saline shortage was the result of the mass destruction caused by Hurricane Helene, which led to the shutdown of the primary IV fluid manufacturing facility in the US.

As a result of this shortage, urologists were faced with 2 choices: cancel cases, or learn to perform procedures such as percutaneous nephrolithotomy (PCNL) with strict limitations on irrigation use. In a recent study, investigators sought to assess whether these restricted irrigation conditions had any impact on PCNL outcomes.

Senior author Roshan M. Patel, MD, sat down with Urology Times® to walk through the rationale for the current study and expand on the events that led to its necessity. He described the shortage as “mission critical”—where hospitals shifted from having an abundance of saline to suddenly needing to be extremely mindful of how much was being used.

“Specifically, [Hurricane Helene] hit the Baxter International Manufacturing Facility in North Carolina. What a lot of us didn't know until the shortage happened was that 60% of the nation's intravenous fluid is produced at that 1 facility. So as soon as it was damaged, it was mission critical everywhere in terms of IV fluid for patients and also for different surgical procedures. It went from having everything in abundance, like we usually do in operating as usual, to all of a sudden we have to be careful because it caused delays in elective surgeries, procedures, and our ability to treat patients.”

Patel is an associate professor of urology, chief of the division of endourology, and the director of the kidney stone center at the University of California, Irvine.

Overall, data showed that restricted irrigation use appeared to be safe and did not negatively impact post-operative outcomes.¹

Specifically, post-operative hemoglobin (P = .53), hemotocrit (P = .37), and creatinine (P = .16) levels were similar between the restricted irrigation cohort and a matched cohort conducted prior to saline restrictions. There was also no difference observed in residual stone burden (P = .29) nor in the distribution of residual stone grades (P = .60).

Based on these data, Patel concluded, “It is possible to conserve fluid when we're trying to do these procedures without compromising patient care.”

REFERENCE

1. Lunow-Luke T, Gao B, Zhou A, et al. Stop the flow: PCNL outcomes under saline-restricted irrigation conditions. J Urol. 2025;213(5S):e670. doi:10.1097/01.JU.0001109944.05171.19.19