The report is published in the September 2006 issue of Urology.

The "mini-PCNL" is described for use in patient with residual fragments after ESWL or with smaller stones in the renal pelvis or lower pole calyces. In this procedure, a 12 Fr nephrostomy tube is left to ensure proper renal drainage, facilitate a second look, if necessary, and ensure hemostasis. The authors evaluated the safety and efficacy of using FloSeal instead of this 12 Fr nephrostomy tube in patients undergoing a mini-PCNL.

Mini-PCNL was performed in 11 patients. Mean stone size was 4.7 cm. Outcomes were compared to 11 consecutive patients undergoing mini-PCNL in which nephrostomy tubes were placed. The mean operative time was 79 minutes. At the end of the procedure, the working tract was pulled out under endoscopic vision to allow for the urothelium to collapse. Five ml of FloSeal was then injected via 9 Fr Amplatz sheath. The skin incision was closed with dermabond. The sealing of the PCNL tract required 3 minutes (range 2 to 5). Antegrade JJ ureteral stents were placed in all patients after the procedure prior to FloSeal injection.

The first five patients underwent IVU and renal ultrasound the morning after the procedure. All patients showed intact collecting systems. The remaining patients underwent renal ultrasound only. In 10 of the 11 patients, the urethral catheter was removed post-op day #1 and all patients had uneventful follow-up. The JJ stent was removed on post-op day #7. In one patient, extravasation was noted and the Foley catheter was kept for 5 days to allow for closure of the collecting system. In this patient, the injection of the FloSeal went into the collecting system instead of outside the kidney, dooming it to fail. There were no bleeding complications in either group. No major complications occurred.

Closure of a mini-PCNL tract with FloSeal seems feasible and provides the option of a tubeless PCNL. The patients were also able to be discharged one day earlier from the hospital which is a great advantage.

Udo Nagele, David Schilling, Aristotelis G. Anastasiadis, Stefan Corvin, Jörg Seibold, Markus Kuczyk, Arnulf Stenzl, Karl-Dietrich Sievert

Urology 68(3):489-494;Sept2006

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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