The value of coagulum pyelolithotomy.

Coagulum pyelolithotomy is a time-saving and tissue-conserving method which minimizes the danger of small crystallizations being left behind for new stone formation. A coagulum of excellent elasticity and tenacity can be obtained from the following mixture: first syringe, 20 ml thrombocyte-enriched plasma plus 5 ml human fibrinogen, and second syringe, 1 ml thrombin plus 4 ml calcium chloride. During the last 7 years this procedure has been employed in 120 selected patients; of these 84 involved multiple stones and 36 a single stone in a dilated intrarenal system. In only six cases were there residual caliceal fragments. The risk of hepatitis seems to be negligible since (1) only HBsAG-negative plasma and blood extracts are used, and (2) a comparison of two groups of 120 pyelolithotomies, with and without the coagulum, showed only two cases of hepatitis in each group while preoperative hepatitis occurred in five and seven cases, respectively. The enzymatic action or urokinase ensures that missing fibrin particles are dissolved before encrustation can occur. All free stones are caught and extracted with the coagulum. In 23% of cases additional fragments, not indicated by preoperative X-rays, were extracted as well.