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[Preventing urinary fistulas in laparoscopic renal conservative parenchyma surgery with purified bovine serum albumin and glutaraldehyde (bioglue). Initial outcomes].

INTRODUCTION
Urinary fistulas remain an important conservative renal parenchyma surgery (CRPS) complication, especially in central or hiliar tumours and bigger than 4 cm. Herein we present our initial experience preventing fistulae with bioglue (Criolife Inc GA, USA) on laparoscopic CRPS in which urinary tract was opened.


PATIENTS AND METHODS
We performed 5 laparoscopic CRPS between September 2005 and February 2006 in which urinary tract was necessarily opened. Previous uretheral catheter, transperitoneal approach, selective arterial control, tumorectomy or heminephrectomy, suturing urinary tract and renal parenchyma and bioglue administration was performed.


RESULTS
Median follow up time was 8.2 months (6-12 months). Median surgery time was 138 minutes (105-180 minutes) with a median ischemia time of 45 minutes (35-60). Uretheral catheter was removed before second post-op day in all cases. Average discharged day was 3.8 (3-5 days). One patient required intraoperative transfusion due to breaking Rummel tourniquet and one arterio- calyceal fistula on tenth day pos-op that required selective embolization remained the worst complication. Neither urinary fistulas nor urinomas were reported.


CONCLUSIONS
Uretheral cathetesim, suturing urinary tract and parenchyma in an independent fashion and applying some kind of surgical adhesive such as bioglue seems to reduce the urinary fistulae risk in laparoscopic CRPS.