Hemostatic Plug: Novel Technique for Closure of Percutaneous Nephrostomy Tract

Abstract

Percutaneous nephrolithotomy (PCNL) is a standard treatment for patients with large or complex kidney stones. The procedure has traditionally included postoperative placement of a nephrostomy tube to allow for drainage and possible reentry. This practice was first implemented after complications incurred after tubeless PCNL in a small patient population. Recently, tubeless PCNL has reemerged as a viable option for selected patients, resulting in decreased pain and analgesic use, shorter hospitalization, quicker return to normal activity, and decreased urine extravasation. Gelatin matrix sealants are occasionally used in nephrostomy tract closure. Techniques for delivery of these agents have been ill described, and placement may be performed with varying results. We present a literature review comparing tubeless PCNL to its traditional variant with indications for use of each, as well as a comparison of agents used in closure. Finally, we outline a novel, reproducible technique for closure of the dilated percutaneous renal access tract.

Left endoscopic combined intrarenal surgery with electrocoagulation hemostasis and right flexible ureteroscopic lithotripsy for bilateral upper urinary tract stones: a case report

“…Techniques such as gelfoam hemostatic plug, injection of gelatin matric hemostatic sealant, and trans-tract electrocoagulation have been attempted to expand the indication of tubeless PCNL by achieving immediate hemostasis ( 14 - 16 ). In our patient with a hypertensive history, electrocauterization with our electrode-rigid ureteroscope device was effective to achieve hemostasis.…”

Trans‐tract electrocoagulation can decrease the need for postoperative nephrostomy tube after endoscopic combined intrarenal surgery

“…In addition to electrocoagulation, tract sealing using fibrin or a gel matrix is known to be an efficient technique for promoting wound healing and reducing hemorrhagic complications. However, these techniques need preparation time and are costly.…”

Outpatient Tubeless Percutaneous Nephrolithotomy Performed in a Freestanding Ambulatory Surgery Center

“…A dissolvable hemostatic plug was advanced down the renal access sheath into the renal access tract before removal of the access sheath. 5 Multilevel (11th and 12th) intercostal anesthetic nerve blocks are performed using 0.5% Marcaine. Incision was closed with 2–0 Vicryl followed by 3–0 Monocryl and skin glue.…”