Immediate closure of nephrostomy tube wounds using a tissue adhesive: a novel approach following percutaneous endourological procedures.

摘要

PURPOSE: We assessed the feasibility of immediate sealing of nephrostomy tube wounds after percutaneous surgery using a tissue adhesive. MATERIALS AND METHODS: The study represents a prospective series of 27 consecutive percutaneous procedures. After nephrostographic exclusion of infrarenal urinary obstruction the nephrostomy tubes were removed and the wound edges were glued together using 2-octyl cyanoacrylate. The wound was covered by gauze to assess the efficiency of sealing and the patients were followed clinically. Another consecutive series of 20 patients who had been treated during 6 months before the current study were used for comparison. The nephrostomy wound in this group was dressed and left to close spontaneously. RESULTS: A total of 27 percutaneous procedures were performed in 25 patients with a median age of 51 years (range 9 to 77). There were 26 cases of percutaneous nephrolithotomy for an average stone burden of 32.6 mm. (range 16 to 70) and 1 pediatric case of percutaneous antegrade balloon dilation of ureteral stricture related to Cohen reimplantation. Median size of the nephrostomy tubes was 16Fr (range 12Fr to 24Fr) and they were maintained a median of 4 days (range 1 to 16) postoperatively. Urinary leakage ceased immediately after tissue adhesive application in all cases. One patient in whom renal colic developed secondary to edema of the ureteral orifice underwent temporary stenting in retrograde fashion. There were no additional complications at a median followup of 5 months (range 3 to 7). The study group had a significantly shorter hospital stay than the wound dressing group (p <0.001). CONCLUSIONS: Wound sealing following nephrostomy tube removal using 2-octyl cyanoacrylate appears to be a safe, simple and efficient method for immediate abolishment of urinary leakage. This novel approach avoids patient and medical personnel inconvenience, permitting early release from the hospital without physical and social limitations related to persistent wound urinary discharge.