Abstract
Objectives
To investigate the outcomes using gelatine matrix hemostatic sealant to close the
tract after mini-percutaneous nephrolithotomy (mini-PCNL), resulting in a tubeless
setting.
Methods
After complete stone removal after mini-PCNL, a double-J ureteral stent was placed in an antegrade manner. After withdrawing the 17F Amplatz
sheet from the collecting system under direct vision without irrigation, the urothelium
collapsed. While retracting the sheet further, the gelatine matrix hemostatic sealant
was injected. The skin incision was closed with glue. An ultrasound examination was
performed on the first postoperative day to exclude the presence of urine extravasation.
Results
Mini-PCNL was performed in 11 patients, either as a primary, small stone, single-access
procedure or as a second-look mini-PCNL because of small residual fragments after
extracorporeal shock wave lithotripsy. The time to seal the mini-PCNL tract through
the kidney parenchyma was 2 to 5 minutes. The mean operative time was 79 minutes.
In the first 5 cases, intravenous urography was performed in addition to ultrasonography
and demonstrated an intact collecting system. The subsequent procedures demonstrated
similar findings, with the exception of 1 case of temporary paravasation. In all other
patients, the catheter was removed on the first postoperative day. Ten of 11 patients
had an uneventful follow-up until removal of the double-J catheter. No major complications were observed.
Conclusions
Closing the tract of the mini-PCNL with gelatine matrix hemostatic sealant is a safe
and fast alternative and provides the option of discharging the patient in good condition
without the commonly used nephrostomy tube.
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References
- Percutaneous nephrolithotomy: one stage or two?.Br J Urol. 1984; 56: 582-585
- Minimally invasive PCNL in patients with renal pelvic and calyceal stones.Eur Urol. 2001; 40: 619-624
- Use of fibrin glue in percutaneous nephrolithotomy.Urology. 2003; 61: 910-914
- Sealing percutaneous nephrolithotomy tracts with gelatine matrix hemostatic sealant: initial clinic use.J Urol. 2004; 171: 575-577
- Percutaneous nephrolithotomy in infants and preschool age children: experience with a new technique.Urology. 1988; 52: 697-701
- Tubeless percutaneous renal surgery.J Urol. 1997; 157: 1578-1582
- Cauterisation of access tract for nephrostomy tube-free percutaneous nephrolithotomy.J Endourol. 2004; 18: 547-549
Article info
Publication history
Published online: September 15, 2006
Accepted:
March 28,
2006
Received:
November 25,
2005
Identification
Copyright
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- Editorial commentUrologyVol. 68Issue 3
- PreviewThe authors present a thorough, nonrandomized, prospective study on the use of gelatine matrix for sealing nephrostomy tube tracts after mini-PCNL. As shown in this study and others using the tubeless technique, complications, such as hemorrhage and persistent clinically evident urine leakage, seem to be no different, although patient convalescence factors are greatly improved. Hemostatic agents are being used as an adjunct to further decrease the potential bleeding complications. Our group explored the use of gelatine matrix because of its properties, including the slight expansion in the cavity into which the substance is injected.
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