Tubeless percutaneous nephrolithotomy (PCNL) is increasingly being used in carefully selected patients to reduce hospital stay and analgesia requirements, especially in those with little bleeding who become stone free or have insignificant residual fragments (usually <4mm). Various agents have been tried to enhance haemostasis in this setting including gelatine matrix and fibrin glue, although the results have not yet shown any statistical benefit. This group from Turkey randomised patients prospectively to receive a placebo or Ankaferd Blood Stopper® (ABS) to determine its efficacy following PCNL. ABS, which has demonstrated ability to control bleeding in tonsillectomy and partial nephrectomy, comprises various plant extracts traditionally used in Turkey for centuries to aid haemostasis and works independently of clotting factors by forming an encapsulated protein network that serves as a platform for vital erythrocyte aggregation. Of the 90 patients carefully selected to undergo tubeless PCNL, 45 patients received ABS. Their technique of haemostatic agent delivery consists of a 4 x 6cm sponge soaked with ABS that was attached to a silk string and pushed through the access port into the kidney under visual and radiological guidance and left in contact with the parenchyma for two minutes. In the placebo group, the access port was left in place for the same duration, although it would have been more comparable if possibly either a sponge soaked with water or not soaked at all was used. There was no statistical difference in the demographic and perioperative variables between the two groups. The end points of the study were to determine the haemoglobin drop and time taken for the urine to clear. There was a statistically significant lower haemoglobin drop (1.40+/-1.04 vs. 1.84+/-1.15) and time for urine to clear (9.60+/-5.50 vs. 11.95+/-4.71) in the ABS group. There were three and four complications in the ABS and placebo groups, respectively. This includes a pseudoaneurysm in the ABS group which required transfusion and embolisation. Compared to other studies comparing haemostatic agents in PCNL without much advantage, ABS certainly seems to be a suitable candidate for enhancing the use of tubeless PCNL, especially since there are no known adverse effects or interactions with other medications and is hypoallergenic. As ever, comparative studies with other haemostatic agents on a larger scale are required to determine the exact role for ABS.
A new haemostatic agent in tubeless PCNL
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