Tubeless percutaneous nephrolithotomy

Abstract

Tubeless PCNL reduces postoperative pain, need for analgesics, hospital stay, and postoperative urinary leakage. “Totally”� tubeless PCNL (in which even a ureteral stent is avoided) may be safely performed in select patients with similar advantages of tubeless PCNL. Tubeless PCNL is facilitated by the use of hemostatic agents-liquid products and flowable or gelatin matrix products. Matrix agents require a bleeding source for fibrinogen, whereas the fibrin sealants do not. Fibrin sealants have both hemostatic and adhesive properties. Since hemostasis and collecting system sealing of a fresh, unsutured percutaneous nephrostomy tract are desired, the use of the liquid sealants may prove to be better suited than the gelatin matrix substances for tubeless PCNL. Diathermal techniques may have a role in enhancing the tubeless PCNL technique, thereby obviating the need for additional hemostatic biomaterials.