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Retrospective Analysis of Percutaneous Stone Surgery Utilizing Nephrostomy Tube versus Tubeless Technique with Fibrin Sealant

Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment of large renal stones. Using fibrin seal-ants for PCNL is known to be safe and feasible. We evaluated the safety, efficacy, and complication rates of tubeless PCNL using fibrin sealant compared to PCNL performed with nephrostomy tube (NT). Materials and Methods: A retrospective review was completed for PCNL performed from January 2002 to October 2006. A total of 141 PCNL were included (81 tubeless/60 NT). We assessed demographics, stone size, blood loss, renal function, hospital stay, targeted stone free rate, and complications. Results: Patient demographics were similar in both groups. Mean stone size was 2.41 cm2 in the tubeless and 2.83 cm2 in the NT group (p = 0.18). The change in creatinine and hemoglobin were not statistically significant between groups. Hospital stay was 1.07 days in the tubeless group versus 2.37 in the NT group (p < 0.0001), with 93% of patients were discharged on post-operative day one versus only 32%, respectively. Immediate targeted stone free rate was 69% in the tubeless group versus 56% in NT group, which improved to 88% and 76% when considering residual stones fragments <4 mm. Long term stone free rates for the tubeless and NT groups were 96% and 83% (p = 0.08) for fragments <4 mm at a median of 3 and 6 months, respectively. Complications in the tubeless group included one pseudoaneurysm, one urine leak, three small subcapsular hematomas, and two re-admissions (one for flank pain and one for non-cardiac chest pain). In the NT group, there was one aborted procedure, two pseudoaneurysms, one colocutaneous fistula, and two re-admissions (one for flank pain and one for urinary obstruction). Conclusion: Tubeless PCNL with fibrin sealants appears to have similar safety and efficacy to traditional NT. In our practice, tubeless PCNL was associated with a decrease in hospital stay.