title: Effects of commonly used hemostatic agents on the porcine collecting system.
abstract: OBJECTIVE
  Topical hemostatic agents have been particularly useful for preventing bleeding in tubeless percutaneous nephrolithotomy. In the present study, we investigated the effect of gelatin matrix hemostatic sealant (FloSeal), fibrin glue (Tisseel,), polyethylene glycol polymers (CoSeal), and bovine serum albumin/ glutaraldehyde (BioGlue) in the pig urinary collecting system after injection through a percutaneous nephrostomy (PCN) tract.
  
  
  METHODS
  Percutaneous nephrostomy was performed in 40 kidneys in 24 domestic pigs. Animals were divided into four groups of six each: (1) FloSeal; (2) Tisseel; (3) CoSeal; and (4) BioGlue. In 16 animals that tolerated the procedure, the contralateral kidney was used as a control for PCN only. All tracts were dilated to 30F with the Amplatz dilator, and 2 mL of the hemostatic agent was injected into the collecting system before pulling back to seal the puncture.
  
  
  RESULTS
  Among the control PCN kidneys, no obstruction was detected at the end of a 5-day period. However, three of six kidneys injected with FloSeal, Tisseel, or CoSeal and four of six kidneys injected with BioGlue were obstructed. In each of these cases, there was an associated retroperitoneal urinoma.
  
  
  CONCLUSIONS
  FloSeal, Tisseel, CoSeal, and BioGlue, if injected directly into the porcine collecting system, can result in significant obstruction that does not resolve over a 5-day period. Until there are clinical data to the contrary, we believe that when using one of these hemostatic agents in association with a tubeless percutaneous procedure, a retrograde occlusion balloon catheter should be considered to prevent inadvertent injection of these materials into the collecting system.
authors.affiliation: Department of Urology, University of California at Irvine, Orange, California 92868, USA.
authors.forename: Isaac Yi
authors.initials: IY
authors.lastname: Kim
authors.forename: Louis
authors.initials: L
authors.lastname: Eichel
authors.forename: Robert
authors.initials: R
authors.lastname: Edwards
authors.forename: Carlos
authors.initials: C
authors.lastname: Uribe
authors.forename: David S
authors.initials: DS
authors.lastname: Chou
authors.forename: Corollos
authors.initials: C
authors.lastname: Abdelshehid
authors.forename: Mike
authors.initials: M
authors.lastname: Ahlering
authors.forename: Shannon
authors.initials: S
authors.lastname: White
authors.forename: Edward
authors.initials: E
authors.lastname: Woo
authors.forename: Elspeth
authors.initials: E
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000818:Animals; D006490:Hemostatics / Q000494:pharmacology*; D034421:Sus scrofa / Q000502:physiology*; D014551:Urinary Tract / Q000187:drug effects*; D014567:Urography
chemical_list: D006490:Hemostatics