Hemostatic sealant in tubeless percutaneous nephrolithotomy: A monocentric experience

Background and aims. Tubeless percutaneous nephrolithotomy is increasingly been used but the question remains on the wisdom of using an hemostatic agents to seal the tract and whether this decision should be based on tract size. We compared the outcome of standard (26-30Fr) tubeless percutaneous nephrolithotomy sealed with Tachosil® vs mini (17.5Fr) percutaneous nephrolithotomy with a tract left unsealed. Methods. We analysed our prospectively maintained Internal Review Board-approved percutaneous nephrolithotomy database to compare outcomes of patients who had undergone tubeless percutaneous nephrolithotomy either sealed or unsealed. Result. Among 491 eligible patients, 294 had a mini (17.5 Fr) unsealed (Group A) and 197 a standard (26-30 Fr) sealed procedure (Group B). Groups were similar for baseline characteristics but median surgical time was significantly shorter (60 vs 75 min; p = 0.0004) in unsealed rather than in sealed procedures. There was no difference in the overall complications rate (44.9 vs 39.1%, p = 0.2); median Hb loss was statistically lower (0.8 vs 1.0; p = 0.028) in unsealed procedures but there was no difference in blood transfusion rate (3.1 vs 3.6%; p = 0.8). Four patients required embolization, 3 (1%) in unsealed and 1 (0.5%) in sealed procedures; 4 had urinary leakage from the flank requiring ureteral stenting, 3 (1%) in unsealed and 1 (0.5%) in sealed procedures. Finally, there was no difference in mean postoperative hospital stay and stone-free rate. Conclusions. Tubeless percutaneous nephrolithotomy were proved to be safe, but elderly patients deserve more attention. The use of sealants, while not always necessary, may be useful in optimizing results.