Hemostatic sandwich to control percutaneous nephrolithotomy tract bleeding

Area of Science:

• Urology
• Minimally Invasive Surgery
• Interventional Radiology

Background:

• Percutaneous nephrolithotomy (PCNL) can lead to rare but severe bleeding complications.
• Conventional methods like tamponade balloons or embolization may be insufficient for refractory hemorrhage.

Purpose of the Study:

• To evaluate the efficacy of a novel gelatin matrix hemostatic sandwich technique.
• To assess its success in managing percutaneous tract bleeding refractory to standard treatments.

Main Methods:

• Retrospective review of four patients with refractory tract hemorrhage.
• Application of a gelatin matrix hemostatic sandwich technique involving dual balloon catheters and sealant injection.
• The technique aims to create a "sandwich" to occlude and seal the nephrostomy tract.

Main Results:

• Successful hemostasis achieved in all four patients with refractory bleeding.
• Average blood loss was 562 mL, with three patients avoiding transfusion.
• No major complications, angioembolization, or renal exploration were required post-procedure.

Conclusions:

• The gelatin matrix hemostatic sandwich technique is a viable option for controlling refractory tract hemorrhage after PCNL.
• This minimally invasive method demonstrates safety and effectiveness in managing severe post-PCNL bleeding.