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Are hemostatic agents for selective cases of tubeless percutaneous nephrolithotomy necessary for access tract control? A randomized control trial

  • Urology - Original Paper
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Abstract

Purpose

To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) access tract sealing agent. Fibrin glue and Tachosil® were used for sealing the access tract and compared to the control. Post operative computed tomography (CT) scan was used to evaluate those efficacies.

Methods

A total of 108 patients were randomized to three groups: In group 1, the access tract was sutured, and compressive dressing was done. In group 2, the fibrin glue was injected into the access tract with a tip applicator at the end of operation. And group 3, Tachosil® was rolled on its longitudinal axis and plugged into the access tract. Non-contrast CT at POD 1 was taken and perirenal hematoma thickness was measured and graded. Hemoglobin, hematocrit, VAS score, stone-free status, and hospital stay were analyzed.

Results

Preoperative demographic differences were not significant in all three arms. Postoperative CT scans in all groups demonstrated mostly minimal grade access tract hematomas. Mean perirenal hematoma thickness showed no significant differences (2.66 ± 3.74, 2.73 ± 3.85, 2.54 ± 4.37 mm, p = 0.981), respectively. Postoperative hemoglobin drop (0.75 ± 0.58, 0.84 ± 0.47, 0.91 ± 0.60 g/dl, p = 0.74), stone-free rate (93.75, 87.87, 87.87%, p = 0.121), VAS (p = 0.499) and hospital stay (1.81 ± 0.84, 1.48 ± 0.71, 1.59 ± 0.75 day, p = 0.127) were not significantly different between the groups.

Conclusion

Fibrin glue and Tachosil® in tubeless PCNL were not necessary for postoperative access tract control.

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Authors and Affiliations

  1. Department of Urology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Yong Sun Choi

  2. VA Medical Center San Diego: VA San Diego Healthcare System, San Diego, USA

    Samuel Ryan Sorkhi

  3. Department of Urology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Sae Woong Choi

  4. Department of Urology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea

    Kang Sup Kim

  5. Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

    Hyuk Jin Cho

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  1. Yong Sun Choi
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Correspondence to Hyuk Jin Cho.

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This study was supported by Research Fund of Seoul St. Mary’s Hospital, The Catholic University of Korea.

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Choi, Y.S., Sorkhi, S.R., Choi, S.W. et al. Are hemostatic agents for selective cases of tubeless percutaneous nephrolithotomy necessary for access tract control? A randomized control trial. Int Urol Nephrol 55, 1093–1100 (2023). https://doi.org/10.1007/s11255-023-03492-6

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