Gelatin Packing of Intracortical Tract After Percutaneous Nephrostomy Lithotripsy for Decreasing Bleeding and Urine Leakage

Abstract

Percutaneous nephrostomy is almost a daily routine procedure in clinical urologic practice. Tract bleeding and urine leakage along the percutaneous tract is a common event and bothersome to both patients and the surgeon. Herein we introduce a simple technique of gelatin packing for stopping subsequent bleeding and urine leakage immediately after a percutaneous nephrostomy lithotripsy (PCNL) procedure. PCNL, using a tubeless technique, was performed in 15 patients with renal calculi. In all cases, stones were removed using grasping forceps after the stones were disintegrated with a lithoclast. In all patients, a retrograde internal ureteral stent was put in place before the PCNL procedure, as was a Foley catheter for bladder drainage. A gelatin patch sealant was placed in the nephrostomy cortical tract under nephroscopic vision, immediately after the PCNL procedure. Another 15 patients, treated using a standard PCNL with tube drainage post-PCNL, were enrolled as a control group. The stone burden, mean operative time, and stone-free rate (67% versus 73%, p = 0.33) were not statistically different between the 2 groups. In the 15 patients who received tubeless PCNL treatment, there were no severe complications related to the gelatin packing in the nephrostomy tract, and no significant bleeding or urine leakage occurred after the packing. The necessity for blood transfusion was much lower in the tubeless group as compared with the tube-drainage group (6.6% versus 26.7%; 0.2 +/- 0.1 units versus 0.9 +/- 0.5 units, p = 0.013). Tubeless patients began ambulation and were discharged from the hospital earlier (3.4 days versus 5.1 days, p = 0.035) than those in the tube-drainage group. Analgesic requirement was significantly less with the gelatin sealant technique when compared with the tube drainage group (85 +/- 20 mg versus 185 +/- 25 mg, p = 0.008). Gelatin sealant packing is an alternative, available, and feasible method for preventing bleeding and urine leakage postoperatively in selected patients receiving tubeless PCNL.