Urothelial Injury from Ethylenediaminetetraacetic Acid Used as an Irrigant in the Urinary Tract

Abstract

Although solutions containing disodium ethylenediaminetetraacetic acid (EDTA) will dissolve calcium oxalate stones in vitro, the safety of such solutions as urinary tract irrigants is questionable. These studies were designed to assess the degree of urothelial damage produced by the mildest EDTA formulation which has been reported to be effective. Rabbit bladders were irrigated antegrade via a ureterotomy for 20 hours and then removed for histological examination. A 0.03 M solution of disodium EDTA at pH 7.5 produced considerably more urothelial injury than did an otherwise identical solution of calcium EDTA (p = 0.006). The bladders from the latter group were undistinguishable from those irrigated with saline. As prior saturation of EDTA with calcium completely eliminated the tissue injury, these studies indicate that the same calcium chelating property which makes this chemical effective also makes it toxic. There was enough tissue damage from the relatively mild formulation used to suggest no EDTA solution yet formulated is safe for clinical use.

EDTA‐induced urothelial cell shedding for the treatment of superficial bladder cancer in the mouse

“…11 It is also approved for oral use in treating heavy metal intoxication. 12 Some groups 13,14 reported urothelial toxicity when using EDTA intravesically. However, these studies differed from our own as they used EDTA at higher concentrations and higher pH values, and the EDTA was administered for prolonged periods of time.…”

Cytotoxicity of EDTA used in biological samples: effect on some human breast‐milk studies

“…The need for exercising greater caution in the use of EDTA in clinical procedures has also been stressed. 15 The inhibitory roles of divalent cations, particularly calcium, suggests a possible methodology by which the toxic activities of EDTA on biological samples could be prevented or at least kept to the barest minimum level, if and when applicable. The ability of divalent cations, particularly zinc and calcium, to inhibit cytolysis has been observed as a common phenomenon involved in the cytotoxic mechanisms of several unrelated agents, including detergents such as fatty acids, haemolytic viruses and complement factors.…”

Cystorraphy, Ischeorectal Tube Cystostomy and Urethrotomy in Bullocks- A Clinical Study of 10 cases

“…However, during the subsequent days drop by drop urination was observed which may be attributed to the painful stimuli due to acidification of urine caused by oral acidifiers (Kane et al, 1989). It may be noted here that ischeorectal tube cystostomy was performed in this group so as to aid in urination along with urethral catheter.…”