title: Cryotherapy of the nephrostomy tract: a novel technique to decrease the risk of hemorrhage after tubeless percutaneous renal surgery.
abstract: OBJECTIVE
  Delayed hemorrhage and significant postoperative pain are associated with complex percutaneous renal surgery. Cryoablation of the percutaneous nephrostomy tract after endoscopic procedures is a potential means of preventing delayed renal hemorrhage. In this study, we investigated the efficacy of this technique by comparing a group of patients who underwent this approach with another group who had nephrostomy tube insertion after percutaneous renal surgery.
  
  
  METHODS
  Sixty patients with complex renal calculi or ureteropelvic junction (UPJ) obstruction underwent percutaneous endoscopic management of their disease. At the conclusion of the procedure, 30 consecutive patients underwent a single 10-minute freeze-thaw cycle, in which a cryoprobe traversed the nephrostomy tract. These 30 patients were compared with the preceding 30 patients who had a nephrostomy tube inserted after complex percutaneous renal surgery.
  
  
  RESULTS
  The two groups were well matched in terms of age, body mass index, total stone burden, number of patients with full staghorn calculi, and number of patients with concomitant UPJ obstruction. The cryotherapy group had a significantly shorter hospital stay (2.1 v 3.6 days, P < 0.001); decreased rates of delayed bleeding episodes (3% v 13%, P < 0.001), and urinary leak (0% v 10%, P < 0.001).
  
  
  CONCLUSIONS
  Cryotherapy of the nephrostomy is a novel means of decreasing the risk of delayed postoperative hemorrhage after complex percutaneous renal surgery. It is associated with significantly decreased length of hospitalization postoperatively, as well as decreased risk of urine leakage compared with nephrostomy tubes in these groups of patients.
authors.affiliation: Smith Institute for Urology, North Shore-Long Island Jewish Health System, New Hyde Park, New York 11040, USA. zokeke@nshs.edu
authors.forename: Zeph
authors.initials: Z
authors.lastname: Okeke
authors.forename: Sero
authors.initials: S
authors.lastname: Andonian
authors.forename: Arun
authors.initials: A
authors.lastname: Srinivasan
authors.forename: Edan
authors.initials: E
authors.lastname: Shapiro
authors.forename: Brian A
authors.initials: BA
authors.lastname: Vanderbrink
authors.forename: Louis R
authors.initials: LR
authors.lastname: Kavoussi
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017679:Cryotherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007430:Intraoperative Care; D007668:Kidney / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012307:Risk Factors; D016896:Treatment Outcome