Nephrostomy-Free Percutaneous Nephrolithotripsy in the Surgical Treatment of Urolithiasis

Urolithiasis is the most common urological pathology requiring surgical treatment. For many decades, the trend has been to abandon open surgery for patients with urolithiasis and to seek and refine the most effective, safe, and minimally invasive treatment methods to improve patients' quality of life and reduce treatment and rehabilitation time. One such method is percutaneous nephrolithotripsy, performed with small-diameter instruments without final external drainage of the upper urinary tract. Reliable hemostasis is key to the effective and safe implementation of this approach. Currently, there is no consensus regarding methods for intraoperative hemostasis of the percutaneous tract. This study presents our positive experience using a hemostatic matrix at the final stage of minipercutaneous nephrolithotripsy. Target: to evaluate the safety and efficacy of using hemostatic matrix in percutaneous surgery for urolithiasis. Materials and methods: the study included 52 patients who underwent minipercutaneous nephrolithotripsy in the urology department of the Alexandro-Mariinsky Regional Clinical Hospital in Astrakhan. As a final step in the surgical procedure, all patients underwent percutaneous tract filling with a domestically produced hemostatic matrices without the need for a nephrostomy drain. Results: the postoperative period in patients operated on using the described technique is characterized by a low need for analgesics, a statistically insignificant decrease in red blood counts, the absence of signs of urine extravasation and the formation of paranephric/retroperitoneal urohematomas. Conclusion: our experience with the nephrostomy-free minipercutaneous nephrolithotripsy method demonstrates its high efficacy and significant improvement in patients' quality of life in the immediate postoperative period, in part due to the elimination of nephrostomy drainage. The introduction of hemostatic agents into the nephrostomy tract facilitates its sealing, reduces the risk of hemorrhagic complications, and overall improves the reliability and safety of this surgical technique for kidney stone treatment.

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