• Christos Rigopoulos, Iason Kyriazis, Panagiotis Kallidonis, Christina Kalogeropoulou, Dimitra Koumoundourou, Ioannis Georgiopoulos, Theodore Petsas, Dimitrios Karnabatidis, Costantinos Constantinides, and Evangelos Liatsikos.
• Department of Urology, University Hospital of Patras, Patras, Greece.
• BJU Int. 2013 Jul 1; 112 (2): E114-21.

ObjectiveTo evaluate the mid-term effects of haemostatic sealant application during tubeless percutaneous nephrolithotomy (PCNL) on renal drainage and histology in an in vivo porcine study.Materials And MethodsBilateral percutaneous access was established in 28 porcine renal units. At the end of the procedure, a type 1 absorbable fish origin collagen powder, a human fibrinogen- and thrombin-coated sponge or a cross-linked gelatin granule/topical thrombin matrix were randomly placed on the nephrostomy tracts. Four nephrostomy accesses were left intact and served as controls. No percutaneous tube, ureteric stent or bladder catheter was left in place postoperatively. Computed tomography urography on postoperative days 1, 15, 30 and 40 was used to access renal drainage. On postoperative day 40, all animals were killed and both kidneys from each animal were harvested for histological evaluation.ResultsEvidence of risk for drainage occlusion after sealant application was found. The use of haemostatic sealants was associated with significant histological lesions in the renal parenchyma, regardless of which sealant was used. No sealant was identified as superior to the others. Nephrostomy tracts that were left without sealant application (control group) were associated with no morbidity and fewer histopathological changes.ConclusionsBased on these experimental results, the safety of the application of haemostatic sealants in tubeless PCNL should be reassessed, focusing not only on the potential of such materials to occlude urinary drainage but also on their effect on renal histology. Further investigation is considered necessary.© 2013 BJU International.

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