Tubeless percutaneous nephrolithotomy with and without a hemostatic product: A prospective, randomized study

Abstract

INTRODUCTION: Guidelines for the use of topical hemostatic products have not been established and their necessity for every case is not determined. The purpose of the present prospective, randomized study was to compare the outcomes of tubeless percutaneous nephrolithotomy (PNL) with and without a hemostatic agent. METHODS: A total of 48 patients with lower calyceal, middle calyceal, or pelvic renal stones ≤ 3 cm were randomly divided into 2 equal groups. All patients received single-stage tubeless PNL through 1 access tract. Group 1 had no local hemostatic agent; group 2 had oxidized regenerated cellulose (Surgicel; Ethicon Inc, Somerville, NJ, USA). Plain kidney, ureter, bladder X-ray and renal ultrasound were performed at the frst postoperative day to evaluate the stone-free rate and detect any perinephric hematoma. Postoperative urinary leakage and postoperative hemoglobin (Hb) were also measured. Patients had ultrasound to determine the amount of the perinephric collection before being discharged. RESULTS: No postoperative urinary leakage through the percutaneous tract was detected in either group. The mean (standard deviation) postoperative reduction in Hb concentration was 1.13 g/dL (1.11) for patients in group 1 and 1 g/dL (0.76) for patients in group 2; the group difference was not signifcant (P =.20). Most patients had no postoperative perinephric collection; minimal collection of 1 cm x 0.5 cm was detected in 2 cases in group 1 and 3 cases in group 2 (P =.30). No patient in either group had perinephric hematoma. Most patients were stone free: 22 patients (91.7%) in group 1; 20 patients (83.3%) in group 2. CONCLUSIONS: Topical hemostatic agents may not be needed after an uncomplicated percutaneous renal procedure. © 2010 UroToday International Journal.

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UroToday International Journal

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