Fibrin Sealant Enables Tubeless Percutaneous Stone Surgery

Noller, Mark W.; Baughman, Steven M.; Morey, Allen F.; Auge, Brian K.

doi:10.1097/01.ju.0000129211.71193.28

Cited by 76 publications

(37 citation statements)

References 12 publications

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“…To date, the use of sealing materials remains controversial because many studies have failed to demonstrate a significant decrease in urinary extravasation or bleeding. [18,19] In contrast, in a prospective study, Maheshwari and coworkers demonstrated no significant increase in the postoperative bleeding in 20 patients who underwent a one-stage tubeless PCNL. [20] In the present study, 3 of 120 cases (2.5%) developed perinephric collection ranging from 50-100 cc.…”

Section: Discussionmentioning

confidence: 92%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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Objective: To evaluate the safety, feasibility and efficacy of tubeless percutaneous nephrolithotomy (PNL) in a supine position in selected cases with renal stones. Materials and methods:This descriptive study enrolled 120 patients who presented to the urology department at Benha Faculty of Medicine with renal stones between June 2009 and June 2010. All patients were evaluated based on their history, a physical examination, kidney, ureter, bladder (KUB), pelviabdominal U/S and spiral CT of the abdomen and pelvis without contrast or IVP in selected cases. The patients were followed up for postoperative pain, leakage and fever. Perinephric collection with ultrasound (U/S) was performed, and the Hb% and hematocrit were determined after 12 hours. Results:The access to the stones was achieved through the lower calyx (70.8%) and middle calyx (29.2%) with a stone clearance rate of 100%, and there was no need for a 2nd session. The mean operative time was (67.1±19.2 min.), and the mean length of the hospital stay was (3.4±1.7 days). Three cases had perinephric collections <100 cc, which were managed conservatively and resolved within one week. Prolonged leakage occurred in three cases and also resolved spontaneously within five days. Three cases required a one-unit blood transfusion postoperatively. Stone-free status was achieved in all cases through the use of either the lower or middle calyx in the supine position during the operation. A single dose of non-steroidal antiinflammatory drugs (NSAID) was needed in 30 cases for postoperative analgesia. Conclusion:Tubeless PNL with the patients in the supine position can be used in selected cases with a favorable outcome and minimal morbidity with the potential advantage of deceases in the postoperative pain, analgesia requirement and hospital stay.Key words: Percutaneous nephrolithotomy; percutaneous nephrostomy; renal stones; tubeless PNL. ÖZETAmaç: Böbrek taşları olan seçilmiş olgularda sırt üstü pozisyonda tüpsüz PNL'nin güvenilirliği, uygulanabilirliği ve etkinliğini değerlendirmek. Gereç ve yöntem: Bu tanımlayıcı çalışmaya Haziran 2009-Haziran 2010 tarihleri arasındaki dönemdeBenha Tıp Fakültesi üroloji bölümüne böbrek taşı ile başvuran 120 hasta alındı. Hastaların tamamı öykü, fizik muayene, DÜS grafisi, pelviabdominal USG, abdomen ve pelvisin kontrastsız spiral BT'si veya seçilmiş olgularda IVP ile değerlendirildi. Hastalar ameliyat sonrası ağrı, sızıntı, ateş, USG ile perinefrik birikim açısından izlendi, %Hb ve hematokrit 12 saat sonra yapıldı. Bulgular: Taşa erişim alt kaliks (%70.8) ve orta kaliks (%29.2) yoluyla yapıldı, taş temizlenme oranı %100'dü. İkinci bir seansa gerek duyulmadı. Ortalama işlem süresi 67.1±19.2 ve ortalama hastanede kalış 3.4±1.7 idi. Üç olguda konservatif olarak tedavi edilen ve bir hafta içinde düzelen <100 cc perinefrik birikim vardı. Üç olguda uzamış sızıntı görüldü, bunlar da beş gün içinde kendiliğinden düzeldi. Üç olguda ameliyat sonrası bir ünite kan transfüzyonu gerekti. Bütün olgularda sırt üstü pozisyonunda alt veya orta...

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Section: Discussionmentioning

confidence: 92%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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“…This might mean that in tubeless PCNL it is not possible to perform hemostasis. Even though it is said that diathermia can be used for intrarenal hemorrhage and fi brin injection can be used for parenchymal bleeding, these are used only in experimental studies (14,15 (17).…”

Section: Commentsmentioning

confidence: 99%

The comparison of standard and tubeless percutaneous nephrolithotomy procedures

Nalbant¹,

Öztürk²,

Şener³

et al. 2012

Int. braz j urol.

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“…In 2004, Noller et al [14] reported the clinical experience of using fibrin sealant to facilitate nephrostomy tube-free PCNL in 10 renal units. No intra-or postoperative complication was noted in their series [14] .…”

Section: Discussionmentioning

confidence: 99%

Tubeless Percutaneous Nephrolithotomy for Geriatric Patients

Jou¹,

Lin²,

Shen³

et al. 2009

Urol Int

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Aim: To evaluate the safety of tubeless percutaneous nephrolithotomy (PCNL) in geriatric patients. Materials and Method: This is a retrospective review of 401 patients who received tubeless PCNL in a single institute. Among these, 50 were performed in patients aged older than 70 years (group 1), while 351 were performed in the remaining younger patients (group 2). Results: There was no significant difference in stone size between the 2 groups (3.6 ± 1.9 vs. 3.5 ± 2.0 cm). The average operative time was similar in both groups (92.8 ± 34.5 vs. 86.6 ± 32.0 min). The stone-free rate in groups 1 and 2 was 68.0% (34/50) and 83.8% (294/351), respectively, which was statistically significantly different. The average postoperative hospital stay was longer in group 1 (4.6 ± 3.4 days) than in group 2 (3.9 ± 2.5 days), but the difference was not statistically significant. There was no significant difference in postoperative urinary tract infection rate and blood transfusion rate in both groups (urinary tract infection: 18.0 vs. 8.8%; blood transfusion: 4 vs. 2.6%). Two patients in group 1 and 3 patients in group 2 experienced pulmonary complications. There was no other severe complication. Conclusion: Tubeless PCNL is a safe procedure for the treatment of geriatric patients with urolithiasis.

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Fibrin Sealant Enables Tubeless Percutaneous Stone Surgery

Abstract: Tubeless PCNL using fibrin sealant at the renal parenchymal defect appears to be safe and feasible. Further experience is necessary to determine the role of fibrin sealant in percutaneous renal surgery.

Cited by 76 publications

References 12 publications

Tubeless PNL in the supine position

Tubeless PNL in the supine position

The comparison of standard and tubeless percutaneous nephrolithotomy procedures

Tubeless Percutaneous Nephrolithotomy for Geriatric Patients

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