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Closing the tract of mini-percutaneous nephrolithotomy with gelatine matrix hemostatic sealant can replace nephrostomy tube placement

Published:September 15, 2006DOI:https://doi.org/10.1016/j.urology.2006.03.081

      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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      Linked Article

      • Editorial comment
        UrologyVol. 68Issue 3
        • Preview
          The 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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      • Reply by the Authors
        UrologyVol. 68Issue 3
        • Preview
          Lee et al.1 were the first to demonstrate the feasibility of closing the access tract during percutaneous surgery by applying GMHS.
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