Tubeless percutaneous nephrolithotomy using hemostatic gelatin matrix.
We describe using hemostatic gelatin matrix (FloSeal; Baxter Inc., Irvine, CA) to provide hemostasis of the tract after percutaneous nephrolithotomy, thereby obviating a nephrostomy tube. For patients who are rendered stone free, a 7F, 11.5-mm occlusion balloon catheter, passed retrograde, is used to occlude the collecting system at the level of entry of the 30F Amplatz sheath. FloSeal is then injected through the partially retracted Amplatz sheath while withdrawing the applicator and the sheath in tandem. The guidewire is withdrawn per urethra until its tip resides in the renal pelvis. A 36-cm, 7F tail stent is passed retrograde, and the skin is closed with cyanoacrylate adhesive (Ethicon, Somerville, NJ). A Foley catheter is placed, to be removed the next morning; the patient can be discharged on postoperative day 1. The ureteral stent is removed in 5 to 7 days as an outpatient procedure.
Borin
James F
JF
Department of Urology, University of California, Irvine, Orange, California 92612, USA.
Sala
Leandro G
LG
Eichel
Louis
L
McDougall
Elspeth M
EM
Clayman
Ralph V
RV
D021721:Balloon Occlusion / Q000295:instrumentation; D005500:Follow-Up Studies; D005780:Gelatin / Q000494:pharmacology*; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014014:Tissue Adhesives / Q000494:pharmacology*; D016896:Treatment Outcome
D014014:Tissue Adhesives; D005780:Gelatin