[Use of a gelatine-thrombin matrix for closure of the access tract without a nephrostomy tube in minimally invasive percutaneous nephrolitholapaxy].
BACKGROUND
The spectrum of percutaneous stone treatment was significantly widened following the introduction of the miniaturized percutaneous nephrolitholapaxy. At the end of the procedure usually a nephrostomy tube was placed to avoid urine paravasation and prolonged bleeding. In this work the tube-less mini-PCNL with direct closure of the access tract was compared to traditional mini-PCNL with placement of the nephrostomy tube.


METHODS
Twenty consecutive patients undergoing mini-PCNL with placement of a nephrostomy tube at the end of the procedure were compared to 20 consecutive patients with direct closure of the access tracts following percutaneous stone removal. Clinical data like decrease in Hb, complications, need for analgesics and duration of hospital stay were compared.


RESULTS
Both groups underwent the procedure without complications. There was no need for blood transfusions. The difference in total analgetic dose was not statistically significant; however, patients in the nephrostomy group needed analgetics for a longer period of time. There was no difference in duration of hospital stay (3.2 days in the tube-less group versus 3.4 days in the nephrostomy group). The primary stone-free rate was higher in the group with direct closure of the access tract (95 versus 85%).


CONCLUSIONS
Closure of the percutaneous access following mini-PCNL with a gelatine-thrombin-haemostatic sealant is a safe alternative to the commonly used nephrostomy tube and can help to reduce postoperative pain and patient discomfort.
Schilling
D
D
Urologische Endoskopie, Klinik für Urologie, Universitätsklinikum, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Deutschland.
Winter
B
B
Merseburger
A S
AS
Anastasiadis
A G
AG
Walcher
U
U
Stenzl
A
A
Nagele
U
U
D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006452:Hemoglobinometry; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007670:Kidney Calices / Q000000981:diagnostic imaging / Q000601:surgery; D007682:Kidney Pelvis / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008904:Miniaturization / Q000295:instrumentation; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014567:Urography
C411004:FloSeal Matrix