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National prospective study on the use of local haemostatic agents during partial nephrectomy

Herve Lang 1 Pascal Mouracade 1 Pierre Gimel 2 Jean Bernhard 3 Géraldine Pignot 4 Laurent Zini 5 Maxime Crépel 6 Jérôme Rigaud 7 Laurent Salomon 8 Laurent Bellec 9 Christophe Vaessen 10 Morgan Roupret 11 Jean Jung Eric Mourey 12 Xavier Martin 13 Pierre Bigot 14 Franck Bruyere 15 Julien Berger 16 Jean Ansieau 17 Franck Salome 18 Jacques Hubert 19, 20 Christian Pfister 21 François Trifard 22 Marc Gigante 23 Hervé Baumert 24 Arnaud Méjean 25 Jean Patard 26
Abstract : OBJECTIVE: To assess the use of local haemostatic agents (HAs) in a prospective multicentre large series of partial nephrectomies (PNs). PATIENTS AND METHODS: Prospective National Observational Registry on the Practices of Haemostasis in Partial Nephrectomy (NEPHRON): the study was conducted in 54 French urological centres from 1 June to 31 December 2010. In all, 570 consecutive patients undergoing a PN were enrolled in this study in a prospective manner. The data was collected prospectively via an electronic case-report form: five different sheets were included for preoperative, perioperative, postoperative and follow-up data respectively. Information related to haemostasis was analysed. RESULTS: The median patient age was 60 years and the mean (range) tumour size was 3.68 (0.19-15) cm. An HA was primarily used in 71.4% of patients, with a statistically significant difference among surgical approaches (P = 0.024). In 91.8% of cases, a single use of a HA was sufficient for achieving haemostasis. The HA was used either alone (13.9%) or in association with sutures (80.3%). One or more additional haemostatic action(s) was needed in 12.3% of the cases. When comparing patients who received a HA with those who did not receive a HA, there was no statistical difference between the groups for tumour size (P = 0.542), collecting system drainage (P = 0.538), hospital stay (P = 0.508), operation time (P = 0.169), blood loss (P = 0.387) or transfusion rate (P = 0.713). CONCLUSION: HAs are widely used by urologists during PN. Progress is needed for standardising HA application, especially for the timing of application. For the time being, the role of the HA in nephron-sparing surgery is still to be evaluated.
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Herve Lang, Pascal Mouracade, Pierre Gimel, Jean Bernhard, Géraldine Pignot, et al.. National prospective study on the use of local haemostatic agents during partial nephrectomy. BJU International, Wiley, 2014, 113 (5b), pp.E56 - E61. ⟨10.1111/bju.12397⟩. ⟨hal-01727560⟩

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