Cauterization of Access Tract for Nephrostomy Tube-Free Percutaneous Nephrolithotomy

Abstract

Nephrostomy tube-free percutaneous renal surgery is a safe and effective procedure for selected patients with minimal hemorrhage after PCNL. Cauterization of tract bleeding points may make this modification a more secure procedure and make it suitable for more patients.

Treatment of Ipsilateral Renal Ureteral Calculi by Combining Retroperitoneal Laparoscopic Surgery with Tubeless Mini-Percutaneous Nephrolithotomy

“…Hoznek et al [21] proposed kidney closure with resorcinol glue after nephrotomy. Endoscopic electrofulguration [22] was also shown to adequately stop bleeding points along the tract.…”

Tubeless percutaneous neprolithotomy: the new gold standard

“…The exclusion criteria reported in some series for this technique include number of punctures, significant bleeding, solitary kidney, urinary tract obstruction, collecting system perforation, renal anomalies, large residual stones requiring a second look, and stone burden [4][5][6]. These limited this approach to selected cases with strict selection criteria.…”

“…Nevertheless, they had to use a PCN in three cases because of significant bleeding and in one because of purulent discharge [7]. Jou et al in 2004 reported that perforation of the collecting system was not a contraindication for tubeless PCNL as long as a DJ stent was fixed [6]. The stone burden was not a limitation for some [5] and to prevent urinary leakage internal or external ureteral stents are routinely used by many authors [4,5,18] although in some reports ureteral stents are also omitted in selected cases, in what is called ''totally tubeless PCNL'' [19,15].…”

“…In recent reports, most of these limitations have been overcome. Nowadays, tubeless PCNL can be performed with multiple punctures, simultaneously in bilateral disease and even in solitary kidneys [6,7]. Some workers advocate sealing the tract with different types of tissue sealant, aiming to minimize urinary extravasations and bleeding [8][9][10].…”

“…Some workers advocate sealing the tract with different types of tissue sealant, aiming to minimize urinary extravasations and bleeding [8][9][10]. Others also advise coagulation of bleeding points inside the kidney and in the tract to minimize postoperative bleeding [11,6]. However randomized studies showed no significant clinical advantages of these maneuvers [12,13].…”