Comparison of outcomes in totally tubeless percutaneous nephrolithotomy according to nephrostomy tract sealing with fibrin versus gelatin matrix: a propensity score matching study


To investigate and compare surgical outcomes in totally tubeless percutaneous nephrolithotomy (ttPCNL) patients according to the type of sealant during nephrostomy tract closure, the records of 158 patients who underwent ttPCNL were retrospectively reviewed. Fibrin sealant [Tisseel®; n = 107, fibrin-only sealant (FS)] or gelatin matrix hemostatic sealant [FloSeal®; n = 51, gelatin matrix sealant (GS)] was applied during tract closure according to surgeon’s preference. On the first postoperative day, computed tomography (CT) was scanned for all patients. Unsatisfactory radiological outcome (URO) was defined as any postoperative hematoma or urinoma (≥ 2 cm) on the CT. Unsatisfactory clinical outcome (UCO) was defined as any adverse event requiring additional intervention. Both UROs and UCOs were sub-classified as either hemorrhage or drainage related. 2:1 propensity score matching was applied according to clinical parameters. Median age was 58 (19–78) years and a mean stone size was 2.1 ± 1.1 cm. The treatment success rate (stone free or < 4 mm residual) among all patients was 91.1% (144/158). UROs and UCOs occurred in 35.4% (86/158) and 11.4% (18/158) of all cases, respectively. Neither of the frequency of URO nor hemorrhage-related UCO was different according to sealant type. However, drainage-related UCOs were more prevalent among the GS group, mainly due to the higher postoperative ureter stenting rate. The postoperative pain severity and the length of hospitalization were comparable between groups. In summary, using GS rather than FS during tract closure did not worsen hemorrhage-related outcomes. However, the clinical risk of ureter occlusion requiring additional temporary ureteral stenting was increased.

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Data availability

Data analyzed during the present study are available from the corresponding author on reasonable request.


  1. 1.

    Fernström I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10(3):257

    Article  Google Scholar 

  2. 2.

    Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L (1997) Tubeless percutaneous renal surgery. J Urol 157(5):1578–1582

    CAS  Article  Google Scholar 

  3. 3.

    Karami H, Gholamrezaie HR (2004) Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol 18(5):475–476

    Article  Google Scholar 

  4. 4.

    Istanbulluoglu MO, Ozturk B, Gonen M, Cıcek T, Ozkardes H (2009) Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. Int Urol Nephrol 41(3):541–545

    Article  Google Scholar 

  5. 5.

    Crook T, Lockyer C, Keoghane S, Walmsley B (2008) A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol 180(2):612–614

    CAS  Article  Google Scholar 

  6. 6.

    Kara C, Resorlu B, Bayindir M, Unsal A (2010) A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology 76(2):289–293

    Article  Google Scholar 

  7. 7.

    Aghamir SMK, Modaresi SS, Aloosh M, Tajik A (2011) Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access. J Endourol 25(4):583–586

    Article  Google Scholar 

  8. 8.

    Chang C-H, Wang C-J, Huang S-W (2011) Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study. Urol Res 39(6):459–465

    CAS  Article  Google Scholar 

  9. 9.

    Yu C, Xu Z, Long W, Longfei L, Feng Z, Lin Q, Xiongbing Z, Hequn C (2014) Hemostatic agents used for nephrostomy tract closure after tubeless PCNL: a systematic review and meta-analysis. Urolithiasis 42(5):445–453

    CAS  Article  Google Scholar 

  10. 10.

    Choe CH, L’Esperance JO, Auge BK (2009) The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy. J Endourol 23(10):1733–1738

    Article  Google Scholar 

  11. 11.

    Hüsch T, Reiter M, Mager R, Steiner E, Herrmann TR, Haferkamp A, Schilling D (2015) The management of the access tract after percutaneous nephrolithotomy. World J Urol 33(12):1921–1928

    Article  Google Scholar 

  12. 12.

    Rosenbaum PR, Rubin DB (1983) The central role of the propensity score in observational studies for causal effects. Biometrika 70(1):41–55

    Article  Google Scholar 

  13. 13.

    Aghamir S, Khazaeli M, Meisami A (2006) Use of Surgicel for sealing nephrostomy tract after totally tubeless percutaneous nephrolithotomy. J Endourol 20(5):293–295

    CAS  Article  Google Scholar 

  14. 14.

    Li R, Louie MK, Lee HJ, Osann K, Pick DL, Santos R, McDougall EM, Clayman RV (2011) Prospective randomized trial of three different methods of nephrostomy tract closure after percutaneous nephrolithotripsy. BJU Int 107(10):1660–1665

    Article  Google Scholar 

  15. 15.

    Shah HN, Hegde S, Shah JN, Mohile PD, Yuvaraja TB, Bansal MB (2006) A prospective, randomized trial evaluating the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. J Urol 176(6):2488–2493

    CAS  Article  Google Scholar 

  16. 16.

    Singh I, Saran RN, Jain M (2008) Does sealing of the tract with absorbable gelatin (Spongostan®) facilitate tubeless PCNL? A prospective study. J Endourol 22(11):2485–2494

    Article  Google Scholar 

  17. 17.

    Wang J, Zhang C, Tan G, Yang B, Chen W, Tan D (2014) The use of adjunctive hemostatic agents in tubeless percutaneous nephrolithotomy: a meta-analysis. Urolithiasis 42(6):509–517

    CAS  Article  Google Scholar 

  18. 18.

    Taylor D (2003) Inactivation of TSE agents: safety of blood and blood-derived products. Transfusion Clinique Et Biologique 10(1):23–25

    CAS  Article  Google Scholar 

  19. 19.

    Uribe CA, Eichel L, Khonsari S, Finley DS, Basillote J, Park HK, Li CC, Abdelshehid C, Lee DI, McDougall EM (2005) What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol 19(3):312–317

    Article  Google Scholar 

  20. 20.

    Ziaee SAM, Sarhangnejad R, Abolghasemi H, Eshghi P, Radfar MH, Ahanian A, Parizi MK, Amirizadeh N, Nouralizadeh A (2013) Autologous fibrin sealant in tubeless percutaneous nephrolithotomy: a prospective study. Urol J 10(3):999

    PubMed  Google Scholar 

  21. 21.

    Lee DI, Uribe C, Eichel L, Khonsari S, Basillote J, Park HK, Li CC, McDougall EM, Clayman RV (2004) Sealing percutaneous nephrolithotomy tracts with gelatin matrix hemostatic sealant: initial clinical use. J Urol 171(2 Pt 1):575–578.

    Article  PubMed  Google Scholar 

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This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HI14C3229).

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Correspondence to Deok Hyun Han.

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The institutional review board of the Samsung Medical Center approved this study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Kim, J.J., Suh, Y.S. & Han, D.H. Comparison of outcomes in totally tubeless percutaneous nephrolithotomy according to nephrostomy tract sealing with fibrin versus gelatin matrix: a propensity score matching study. Urolithiasis 48, 151–158 (2020).

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  • Tubeless
  • Percutaneous nephrolithotomy
  • Tract closure
  • Sealant