Percutaneous Injection of Fibrin Glue Resolves Persistent Nephrocutaneous Fistula Complicating Colonic Perforation after Percutaneous Nephrolithotripsy

Miranda, Eduardo; Ribeiro, Gustavo Pinto; Almeida, Diego Costa; Scafuri, Ariel Gustavo

doi:10.1590/s1807-59322009000700017

Cited by 9 publications

(7 citation statements)

References 7 publications

(3 reference statements)

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“…Persistent nephrocutaneous fistula may complicate colonic perforation after PCNL. In such case, percutaneous injection of fibrin glue might be efficient [28].…”

Section: Discussionmentioning

confidence: 99%

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

et al. 2012

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“…Persistent nephrocutaneous fistula may complicate colonic perforation after PCNL. In such case, percutaneous injection of fibrin glue might be efficient [28].…”

Section: Discussionmentioning

confidence: 99%

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

et al. 2012

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“…Two other techniques are described where fibrin sealant was injected into the fistula tract and a ureteric stent was inserted through a retrograde approach under fluoroscopic guidance. These cases differed from ours in the additional use of a urethral catheter to prevent urine reflux from the bladder up to the kidney, which is a result of the ureteric stent causing urine to bypass the vesico‐ureteric antireflux mechanism …”

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confidence: 60%

“…These cases differed from ours in the additional use of a urethral catheter to prevent urine reflux from the bladder up to the kidney, which is a result of the ureteric stent causing urine to bypass the vesico-ureteric antireflux mechanism. 5,6 The merit of our technique is the combination of direct injection of fibrin sealant into the fistula tract to ensure complete healing, dilation to de-epithilialize/remove the avasular area and the use of nephrostomy drainage rather than ureteric stenting. The nephrostomy helps to avoid the additional prolonged and inconvenient use of a urethral catheter to prevent ureteric reflux.…”

Section: Management Of a Patient With A Chronic Nephrocutaneous Fistumentioning

confidence: 99%

Management of a patient with a chronic nephrocutaneous fistula after partial nephrectomy using a novel technique

et al. 2014

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smaller than 3 cm.2 Although most renal tumors associated with BHDS behave in an indolent manner, the presence of clear cell components in renal tumors could reflect a worse prognosis.3 As FLCN is linked to the mammalian target of rapamycin pathway, mammalian target of rapamycin inhibitors could be effective for BHDS patients with metastasis. 2 The prompt preparation of international medical guideline for diagnosis and management in BHDS-associated renal tumors might be desirable. Partial nephrectomy is the preferred choice for the treatment of small renal tumors (T1a, T1b). One of the recognized complications of this procedure is urine leak, which occurs in 1.4-17.4% of patients, 1 and urine fistula with an incidence of 3-6%. 2 These can normally be managed conservatively. On rarer occasions, small renal tumors need to be managed with percutaneous drain, stent, nephrostomy or total nephrectomy as a last resort. We present a case of a chronic nephrocutaneous fistula resulting after a prolonged urine leak from an open partial nephrectomy, which was managed with an innovative and novel technique. This involved insertion of a percutaneous nephrostomy and injection of fibrin sealant into the fistula tract. Management of a patient with a chronic nephrocutaneous fistula after partial nephrectomy using a novel techniqueA 69-year-old man presented with an incidental finding of a 5.5-cm, left-sided, mid-zone renal mass suspicious of T1b renal cell carcinoma (Fig. 1). His comorbidities included hypertension. The patient underwent an open partial nephrectomy during which the collecting system was opened (ischemic time 20 min). The defect was closed with an absorbable monofilament suture using a two-layer technique, a hemostatic matrix and an absorbable hemostatic agent bolster.Postoperatively, there was a high output of urine from the drain. At 2 weeks, the leak persisted; therefore, a cystoscopy and retrograde study were carried out, which showed a leak in the upper pole calyx. A ureteric stent (6-Fr 24 cm) and a urethral catheter were inserted. The drain, ureteric stent and catheter were removed once the leak dried at 5 weeks. The patient was found to have a nephrocutaneous fistula at 12 weeks confirmed by a fistulagram (Fig. 1). At 24 weeks, another ureteric stent (6-Fr 26 cm) and urethral catheter were inserted. DOI: 10.1111/iju.12641 At 28 weeks, the urine leak persisted; therefore, the stent was removed, and a retrograde study was carried out. A nephrostomy (10-Fr) was inserted into the lower pole calyx, away from the area of previous surgery (Fig. 1). The sinus tract at the upper pole was then dilated to 30-Fr in case a nephroscopy would be required to inject the sealant under vision. This was carried out from the skin down to the kidney under image intensifier guidance. Then, 4 mL of a fibrin sealant (Teeseal; Baxter Healthcare Corporation, Liverpool, UK) was injected blindly into the sinus tract and the leaking point, using an applicator that stops fibrin from migrating out of the tract (Duplospray MIS; Baxter...

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“…[7][8][9][10] Lately, fibrin sealants are recommended in persistent nephrocutaneous fistulas. 10,11 Sposgostan has been used for fistulas in the gastrointestinal system. 12,13 The mechanism of action of spongostan is supportive and mechanical.…”

Section: Discussionmentioning

confidence: 99%

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy

Ün

Çakır²,

Köse³

et al. 2015

CUAJ

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Percutaneous nephrolithotomy (PCNL) is the first-line treatment for kidney stones. Colon perforation is a rare, but dangerous, complication. Colonic perforation might be very serious if it is not found early. After an unsuccessful extracorporeal shockwave lithotripsy, a 45-year-old female underwent a left-sided PCNL for two 1-cm kidney stones in the left kidney upper pole calyx. During dilatation, a colon perforation was suspected. The procedure was finished by inserting a 14Fr re-entry catheter into the colon. On postoperative day 5, a fluoroscopy was performed by injecting contrast dye through the re-entry catheter, which showed a fistula formation between skin and colon. The catheter was removed completely. A 16Fr external drainage catheter was inserted over the guidewire through the fistula tract. The fistula was closed by introducing prepared absorbable hemostatic gelatin powder (Spongostan) particles into the fistula tract through the catheter. Fistula tracks can be closed early by injecting absorbable Spongostan particles into the colonic fistula tract, thereby reducing inpatient time and increasing patient comfort.

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Percutaneous Injection of Fibrin Glue Resolves Persistent Nephrocutaneous Fistula Complicating Colonic Perforation after Percutaneous Nephrolithotripsy

Cited by 9 publications

References 7 publications

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

Management of a patient with a chronic nephrocutaneous fistula after partial nephrectomy using a novel technique

Colon perforation during percutaneous nephrolithotomy and fistula closure with Spongostan following conservative therapy

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