Evaluation of Use of Different Local Hemostatic Materials for Closure of the Percutaneous Nephrolithotomy Tract

Abstract
Background: Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large stones >2cm in diameter within the kidney, placement of a percutaneous nephrostomy tube for hemostasis, drainage and for second look has been an integral part of the standard PCNL procedure, however the procedure has been modified to tubeless PCNL to decrease hospital stay and analgesic use duration. Many studies advice for the use of adjuvant local hemostatic sealants to decrease both bleeding and extravasation.
Objective: Evaluation of local hemostatic sealants used in tubeless PCNL.
Methods: One hundred and fifty patients with renal stone 2-3cm in diameter who were enrolled for PCNL were divided into five equal groups; groups from 1 to 4 had tubeless PCNL.
We used Gelatin matrix hemostatic sealant (Surgiflo), collagen sponge coated with thrombin and fibrinogen (Tachosil), oxidized cellulose (Surgicel), gelatin sponge (Gelfoam) in the 1st, 2nd, 3rd and 4th respectively while in the 5th group standard PCNL was done.
We compared the groups regarding demographic data, stone site and size, intraoperative time, estimated blood loss (Hematocrit value drop in % before and after PCNL), post-operative pain, analgesic duration, length of hospital stay, complications, and cost.
Results: Between the five groups, no significant difference concerns the demographic data stone size and site, intraoper-ative time, estimated blood loss and complications and a significant difference concerning the cost, hospital stay, visual pain analogue scale and analgesic use duration.
Conclusion: The use of local hemostatic sealants is safe and to be considered for cases who underwent tubeless PCNL.
There were no significant differences among the four sealants used in the present study as regard applicability, safety and overall complications post-operatively.
However the Tachosil material is found to be costy when compared to the other materials.
Further studies including large group of patients as well as more complex stones are required in the future.