title: Assessing the use of haemostatic sealants in tubeless percutaneous renal access and their effect on renal drainage and histology: an experimental porcine study.
abstract: OBJECTIVE
  To evaluate the mid-term effects of haemostatic sealant application during tubeless percutaneous nephrolithotomy (PCNL) on renal drainage and histology in an in vivo porcine study.
  
  
  METHODS
  Bilateral percutaneous access was established in 28 porcine renal units. At the end of the procedure, a type 1 absorbable fish origin collagen powder, a human fibrinogen- and thrombin-coated sponge or a cross-linked gelatin granule/topical thrombin matrix were randomly placed on the nephrostomy tracts. Four nephrostomy accesses were left intact and served as controls. No percutaneous tube, ureteric stent or bladder catheter was left in place postoperatively. Computed tomography urography on postoperative days 1, 15, 30 and 40 was used to access renal drainage. On postoperative day 40, all animals were killed and both kidneys from each animal were harvested for histological evaluation.
  
  
  RESULTS
  Evidence of risk for drainage occlusion after sealant application was found. The use of haemostatic sealants was associated with significant histological lesions in the renal parenchyma, regardless of which sealant was used. No sealant was identified as superior to the others. Nephrostomy tracts that were left without sealant application (control group) were associated with no morbidity and fewer histopathological changes.
  
  
  CONCLUSIONS
  Based on these experimental results, the safety of the application of haemostatic sealants in tubeless PCNL should be reassessed, focusing not only on the potential of such materials to occlude urinary drainage but also on their effect on renal histology. Further investigation is considered necessary.
authors.affiliation: Department of Urology, University Hospital of Patras, Patras, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Rigopoulos
authors.forename: Iason
authors.initials: I
authors.lastname: Kyriazis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kallidonis
authors.forename: Christina
authors.initials: C
authors.lastname: Kalogeropoulou
authors.forename: Dimitra
authors.initials: D
authors.lastname: Koumoundourou
authors.forename: Ioannis
authors.initials: I
authors.lastname: Georgiopoulos
authors.forename: Theodore
authors.initials: T
authors.lastname: Petsas
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karnabatidis
authors.forename: Costantinos
authors.initials: C
authors.lastname: Constantinides
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
mesh_terms: D000818:Animals; D003094:Collagen / Q000627:therapeutic use*; D004322:Drainage; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D007668:Kidney / Q000473:pathology* / Q000502:physiology*; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D015503:Surgical Sponges; D013552:Swine; D013917:Thrombin / Q000627:therapeutic use*; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D004338:Drug Combinations; C411004:FloSeal Matrix; D006490:Hemostatics; C518955:TachoSil; D014014:Tissue Adhesives; D005340:Fibrinogen; D003094:Collagen; D013917:Thrombin