Abstract
The purpose of this study was to determine the efficacy and safety of tubeless percutaneous nephrolithotomy (PNL) using a non-absorbable hemostatic sealant (Quikclot®) as an adjunct compared to nephrostomy tube placement in patients exhibiting significant parenchymal bleeding following PNL. We identified 113 PNL cases performed between May 2011 and October 2014. For patients with insignificant parenchymal bleeding following stone removal, defined as a clear visualization of the surgical field at full irrigation of the nephroscope, tubeless PNL was performed. For patients with significant parenchymal bleeding, we introduced the tubeless Quikclot® technique as of September 2013 and have performed it ever since. Formerly, nephrostomy placement PNL was performed. In this study, 40 Quikclot® applied PNL cases were matched with an equal number of nephrostomy placement cases by propensity scoring based on body mass index, stone size, and Guy’s stone score. The mean postoperative drop in hematocrit was comparative between the Quikclot® group and the nephrostomy group on both postoperative days 1 (p = 0.459) and 2 (p = 0.325). Quikclot® application was associated with lower VAS scores throughout the postoperative period, lower cumulative analgesic requirement (p = 0.025), and with shorter hospitalization (p = 0.002). Complication rates were comparable with no need for blood transfusions in any patients. Tubeless Quikclot® PNL was safe and provided effective hemostasis of significant parenchymal bleeding. By avoiding nephrostomy placement, we were able to reduce postoperative pain, analgesic requirements, and hospitalization. Application of Quikclot® may be considered prior to nephrostomy placement in patients with significant parenchymal bleeding.
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References
Hwang TK (2010) Percutaneous nephroscopic surgery. Korean J Urol 51:298–307
Shah HN, Hegde S, Shah JN, Mohile PD, Yuvaraja TB, Bansal MB (2006) A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. J Urol 176:2488–2492
Gupta NP, Mishra S, Suryawanshi M, Seth A, Kumar R (2008) Comparison of standard with tubeless percutaneous nephrolithotomy. J Endourol 22:1441–1446
Borges CF, Fregonesi A, Silva DC, Sasse AD (2010) Systematic review and meta-analysis of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Endourol 24:1739–1746
Ni S, Qiyin C, Tao W et al (2011) Tubeless percutaneous nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: a meta-analysis of randomized, controlled trials. Urology 77:1293–1298
Nagele U, Schilling D, Anastasiadis AG et al (2006) Closing the tract of mini-percutaneous nephrolithotomy with gelatine matrix hemostatic sealant can replace nephrostomy tube placement. Urology 68:489–493
Noller MW, Baughman SM, Morey AF, Auge BK (2004) Fibrin sealant enables tubeless percutaneous stone surgery. J Urol 172:166–1669
Yu C, Xu Z, Long W et al (2014) Hemostatic agents used for nephrostomy tract closure after tubeless PCNL: a systematic review and meta-analysis. Urolithiasis 42:445–453
Rigopoulos C, Kyriazis I, Kallidonis P et al (2013) Assessing the use of haemostatic sealants in tubeless percutaneous renal access and their effect on renal drainage and histology: an experimental porcine study. BJU Int 112:E114–E121
Wang J, Zhang C, Tan G, Yang B, Chen W, Tan D (2014) The use of adjunctive hemostatic agents in tubeless percutaneous nephrolithotomy: a meta-analysis. Urolithiasis 42:509–517
Basadonna G (2012) QuikClot combat gauze for hemorrhage control. Prehosp Disaster Med 27:217
Tiselius HG, Andersson A (2003) Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 4:275–281
Matlaga BR, Hyams ES (2011) Stones: can the Guy’s stone score predict PNL outcomes? Nature Rev Urol 8:363–364
Zhong Q, Zheng C, Mo J, Piao Y, Zhou Y, Jiang Q (2013) Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis. J Endourol 27:420–426
Choe CH, L’Esperance JO, Auge BK (2009) The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy. J Endourol 23:1733–1738
Uribe CA, Eichel L, Khonsari S et al (2005) What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol 19:312–317
Kim IY, Eichel L, Edwards R et al (2007) Effects of commonly used hemostatic agents on the porcine collecting system. J Endourol 21:652–654
Lipkin ME, Mancini JG, Simmons WN et al (2011) Pathologic evaluation of hemostatic agents in percutaneous nephrolithotomy tracts in a porcine model. J Endourol 25:1353–1357
Kheirabadi BS, Mace JE, Terrazas IB et al (2010) Safety evaluation of new hemostatic agents, smectite granules, and kaolin-coated gauze in a vascular injury wound model in swine. J Trauma 68:269–278
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Koo, K.C., Park, S.U., Jang, H.S. et al. Tubeless percutaneous nephrolithotomy with non-absorbable hemostatic sealant (Quikclot®) versus nephrostomy tube placement: a propensity score-matched analysis. Urolithiasis 43, 527–533 (2015). https://doi.org/10.1007/s00240-015-0796-y
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DOI: https://doi.org/10.1007/s00240-015-0796-y