Initial Experience with Hemostatic Fibrin Glue as Adjuvant during Tubeless Percutaneous Nephrolithotomy

Shah, Hemendra N.; Kausik, Vikram B.; Hedge, Sunil; Shah, Jignesh; Bansal, Manish

doi:10.1089/end.2006.20.194

Cited by 34 publications

(24 citation statements)

References 19 publications

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“…With a mean stone size of 2.9 cm 2 , we achieved an absolute stone free rate of 72%, and 90% were stone free when excluding fragments of < 4 mm. These results are consistent with published data using rigorous criteria and based on immediate postoperative CT ( Table 3 ) [ 4,5,8,9 ] . Patients were discharged on postoperative day 1 in most cases.…”

Section: Discussionsupporting

confidence: 92%

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Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases

et al. 2012

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Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Small case series support the safety and efficacy of tubeless PCNL with fibrin sealant. However, there is a paucity of data from larger case series supporting this approach.To our knowledge, this is among the largest tubeless PCNL series. We found the use of fibrin sealant for tubeless PCNL was associated with excellent stone‐free rates (approaching 90%), short hospitalisation, and low complication rates. Tubeless PCNL with nephrostomy tract fibrin sealant appears to be viable option for appropriately select patients.OBJECTIVE To report on our first 107 cases of tubeless percutaneous nephrolithotomy (PCNL) using fibrin sealant as a haemostatic agent within the access tract. PCNL is the preferred treatment for patients with large renal stones, and the tubeless technique with the use of fibrin sealant has recently gained popularity. PATIENTS AND METHODS We performed a retrospective review of single‐access, PCNL cases performed without a nephrostomy tube from January 2002 to July 2008. Nephrostomy tracts were sealed at the conclusion of each procedure with fibrin‐containing haemostatic agents. We evaluated demographic variables, tracked complications, and compared pre‐ and postoperative haemoglobin, haematocrit and creatinine levels. On postoperative day 1 computed tomography was used to determine stone‐free rates. Student's t‐test calculations were used to determine statistical significance at P≤ 0.05. RESULTS In all, 59 men and 48 women with a mean age of 43 years were included in the analysis of 107 cases. The mean stone size was 2.9 cm2 and the average hospital stay was 1.07 days. Pre‐ and postoperative changes in serum haemoglobin and serum creatinine were not statistically different. Postoperative haematocrit declined by a mean of 4.5% (P≤ 0.05), but no patients required a transfusion. Stone‐free rates were 72% overall, and 90% when excluding patients with residual fragments of <4 mm. Complications included seven asymptomatic subcapsular haematomas, one pseudoaneurysm requiring selective embolization, one urine leak, and five return visits to the emergency room for pain. CONCLUSIONS The use of fibrin sealant in this large tubeless PCNL series was associated with favourable stone‐free rates, short hospital stays, and low complication rates with no significant bleeding. Tubeless PCNL with nephrostomy tract fibrin sealant appears to be a viable option for appropriately selected patients, but future randomised trials are warranted.

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Section: Discussionsupporting

confidence: 92%

“…Shah et al . [ 8 ] when comparing tubeless PCNL with and without tissue sealants favours the use of tissue sealants for the reduction of postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases

et al. 2012

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“…Other studies have use morphine, pethidine and diclofenac. [13][14][15] Patients were evaluated by visual analog scoring system. Standard PCNL patients had more pain compared to tubeless PCNL patients.…”

Section: Discussionmentioning

confidence: 99%

Tubeless per cutaneous nephrolithotomy: is it the present standard of care?

et al. 2017

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INTRODUCTIONRenal calculi are the most common cause for pain in patients with urological problems and their recurrence rate is also very high to the tune of 70%.1 Various options are available for their treatment ranging from open surgery to extracorporeal shock wave lithotripsy (ESWL). For large stone burden, per cutaneous nephrolithotomy (PCNL) is the standard of care.2,3 Per cutaneous nephrolithotomy was first introduced by Fernstrom and Johansson and rapidly gained acceptance as the standard of care for removal of large and complex renal calculi. 4 Since then a lot of modifications have been introduced in the techniques and instrumentation of PCNL.In a standard PCNL, a 30Fr Amplatz sheath is placed after dilatation of the tract and calculi are retrieved after fragmentation. Either a double J (DJ) stent is placed or Ureteric catheter is retained. A nephrostomy tube is placed post procedure for haemostatic tamponade effect and to access the system in case of significant residual ABSTRACT Background: Since the time standard per cutaneous nephrolithotomy (PCNL) was introduced in 1976, it has undergone changes in techniques, instrumentation and post-operative management for better patient care. Standard PCNL involves placement of nephrostomy tube and DJ stent/ureteric catheter after stone retrieval. Now the trend is towards tubeless PCNL and totally tubeless PCNL as to minimize pain, infection and hospital stay. Our objective was to compare the outcome of standard PCNL with tubeless PCNL. Methods: This was a randomized study of patients who underwent standard PCNL and tubeless PCNL in our institute from August 2013 to August 2015 for renal calculi >2 cms. Patients with residual calculi needing further ancillary treatment and patients who had major collecting system tear were excluded from the study. A total of 257 patients who had undergone PCNL during the study period for renal calculi >2 cm were included in the study. 27 patients were excluded due to presence of residual calculi or major collecting system tear. Of these 115 underwent standard PCNL and remaining 115 tubeless PCNL. Post-operative visual analog pain score, need for analgesics, infection rate, post-operative hospital stay were analyzed. Results: No significant differences were noted in patient demographics, age, sex, stone size and stone burden. There were no significant complications seen in tubeless group as compared to standard PCNL group. Post-operative pain and hospital stay was significantly reduced in tubeless PCNL group. Conclusions: Tubeless PCNL is a relatively safe and effective modification of standard PCNL. It increases patient compliance of PCNL by reducing post-operative pain and early recovery.

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“…Yu et al [26] included six randomized controlled trails [22][23][24][25][27][28][29] and two case control studies [6,30] which compared haemostatic agents with common methods (silk stitch or pressure dressing). There was no significant statistical difference in operation time, blood loss, transfusion rate, fever or complication rate.…”

Section: Clinical Trialsmentioning

confidence: 99%

“…Wang et al [31] included five prospective randomized studies [23-25, 29, 32] and two retrospective studies [6,30] which compared haemostatic agents with common methods as well. Studies performed by totally tubeless PCNL were excluded in this meta-analysis.…”

Section: Clinical Trialsmentioning

confidence: 99%

The management of the access tract after percutaneous nephrolithotomy

et al. 2015

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Initial Experience with Hemostatic Fibrin Glue as Adjuvant during Tubeless Percutaneous Nephrolithotomy

Abstract: Use of fibrin glue was safe and was associated with less analgesic requirement and a shorter hospital stay. Randomized studies are needed to evaluate its clinical role in the future.

Cited by 34 publications

References 19 publications

Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases

Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases

Tubeless per cutaneous nephrolithotomy: is it the present standard of care?

The management of the access tract after percutaneous nephrolithotomy

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