A Safe Technique for Control of Bleeding after Percutaneous Nephrolithotomy

Abstract

Introduction: We investigated the efficacy of nephrostomy balloon catheter inflation in the access tract for the control of bleeding after percutaneous nephrolithotomy (PCNL). Materials and Methods: Sixty five patients who had undergone PCNL for kidney stones in our clinic between April 2006 and July 2008 were included in the study. Patients have been selected consecutively and randomized in 2 groups. In the first group which consisted of 33 patients (Group I), a 16 Ch nephrostomy tube has been left in the tract following PCNL. The second group consisted of 32 patients (Group II) and the nephrostomy balloon catheter was inflated at 10 atmosphere pressure at the end of the procedure and left in the tract for 24 h postoperatively. Preoperative and postoperative hemoglobin values at 24 h were compared statistically with regard to bleeding between both groups. Results: Average hemoglobin values at postoperative 24 h were 9.28 g/dl in the first and 10.65 g/dl in the second group. The difference between the 2 groups was statistically significant (p < 0.001). Conclusions: Inflation of nephrostomy balloon catheter in the access tract after PCNL is a safe and useful method for the control of bleeding.

Current insights on haemorrhagic complications in percutaneous nephrolithotomy

“…Intraoperatively, bleeding can be controlled by the use of a large-bore nephrostomy tube which should be clamped for 4–8 h. If the urine from Foleys catheter clears out, a trial of declamping can be attempted, otherwise, it should be clamped for 24–48 h for persistent bleeding [ 20 , [82] , [83] , [84] ]. Other options that have been used instead of the nephrostomy tube are balloon dilator, Kaye nephrostomy tamponade catheter, or a nephrostomy tube covered with absorbable haemostatic gauze [ 59 , 85 , 86 ]. A Kaye tamponade catheter can also be applied later if clamping the large bore nephrostomy tube does not sufficiently control bleeding.…”

The impact of nephrostomy balloon inflation volume on post percutaneous nephrolithotomy hemorrhage

“…In an original article concerning the safest technique for management bleeding post-PCNL, Tahir Karadeniz et al . mentioned that the inflation of the nephrostomy balloon tube in the PCNL tract is an efficient technique for postoperative bleeding control [ 13 ]. Therefore, this supports our results regarding the post PCNL bleeding control by increasing the quantity of the nephrostomy balloon catheter inflation within the amount that not inflicting that a lot of important severe postoperative pain.…”