title: Hemostatic agents for access tract in tubeless percutaneous nephrolithotomy: Is it worth?
abstract: BACKGROUND
  The role of hemostatic agents as an adjunct for closure of the nephrostomy tract in tubeless percutaneous surgery (tubeless percutaneous nephrolithotomy [tPNL]) has been previously evaluated, observing a potential benefit in terms of reduced bleeding and urinary leakage. We assessed the rate of postoperative complications after the use of hemostatic agents for sealing the nephrostomy tract in patients undergoing tPNL at our institution.
  
  
  METHODS
  We performed a retrospective analysis of 52 consecutive patients undergoing tPNL at our center between January 2010 and December 2013. No substance was placed within the tract in 25 patients (Group 1). A cylinder of Surgicel(®) in addition to 1 unit of Gelita(®) were placed within the access tract in 27 patients (Group 2). We accounted for demographic variables, stone size, operative time, postoperative pain, development of hematoma, postoperative hematocrit drop, urinary leakage, residual lithiasis, and hospital stay length.
  
  
  RESULTS
  Age and sex differed significantly between the two groups (P = 0.0002 and P = 0.048 respectively). However, there were no significant differences in terms of body mass index and stone burden. No significant differences between groups were found with regards to operative time, postoperative hematocrit drop, postoperative pain and presence of residual lithiasis.
  
  
  CONCLUSIONS
  The use of Gelita(®) and Surgicel(®) as hemostatic agents in tPNL is safe, but we were not able to demonstrate any significant benefit in terms of postoperative morbidity after comparing the use of these agents in tPNL. We concluded that the uses of hemostatic agents needed to be evaluated in prospective randomized trials to define its benefits.
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Sepulveda
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Aliaga
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Daniela
authors.initials: D
authors.lastname: Fleck
authors.affiliation: Department of Urology, Clínica Alemana de Santiago, Santiago de Chile, Santiago, Chile.
authors.forename: Mario
authors.initials: M
authors.lastname: Fernandez
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mercado
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Roberto
authors.initials: R
authors.lastname: Vilches
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Francisco
authors.initials: F
authors.lastname: Moya
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ledezma
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Diego
authors.initials: D
authors.lastname: Reyes
authors.affiliation: Department of Urology, Hospital Clínico de la Universidad de Chile, Universidad de Chile, Santiago, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Marchant
keywords: Hemostatics; intraoperative complications; nephrolithotomy; percutaneous nephrostomy; tubeless nephrolithotomy