Hemostatic Sandwich to Control Percutaneous Nephrolithotomy Tract Bleeding

Abstract

This novel hemostatic sandwich technique should be considered as an option for the control of refractory tract hemorrhage after PCNL.

Evaluating the efficacy of bimanual compression of abdomen-flank to control postoperative bleeding after percutaneous nephrolithotomy: A randomized clinical trial

“…5 Traditionally some surgeons use bimanual compression of the abdomen and flank to compress the kidney and surrounding tissues in the Gerota’s space to stop massive bleeding from the PCNL tract at the end of the procedure. 4,8 However, we could not find any evidence in the literature supporting the efficacy of such a maneuver. As the compression time is up to 15–20 min in some centers, inefficacy of such a maneuver will lead to a waste of valuable time.…”

“…The use of manual or bimanual compression to control significant bleeding from the access tract after completion of PCNL operation has been reported in some studies. 4,8,19 In a randomized clinical trial, Etemadian et al 8 investigated the value of keeping nephrostomy tube in control of postoperative bleeding after PCNL. They inserted nephrostomy tube in one of their studied groups and in the other group, they routinely applied external flank pressure for 3–4 min after removal of Amplatz sheath to control and pack bleeding.…”

“…Then they applied external skin pressure for 5–10 min to control postoperative bleeding from the PCNL tract. 4 In another study on the management of hemorrhage after PCNL published as early as 1995, Kessaris et al 19 recommended leaving nephrostomy tube, external skin pressure, and compression dressings as initial maneuvers to control mild to moderate bleeding form PCNL tract. Nevertheless, up to our best knowledge, the efficacy of external skin pressure or combination of external skin pressure and concomitant abdominal pressure to control postoperative bleeding form PCNL tract has not been evaluated before.…”

“…However, PCNL is associated with well-established complications up to a total frequency of 20.5% 1,2 and transfusion frequency ranging from <1% up to 55%. 3–5 Perioperative renal bleeding is the most common and worrisome complication of PCNL. 5 Most cases of perioperative or late postoperative PCNL bleeding can be managed conservatively, however, intervention is required in a minority of cases.…”