Use of absorbable gelatin sponge as an adjunct to "totally tubeless percutaneous nephrolithotomy".

OBJECTIVES To study the efficacy and safety of totally tubeless percutaneous nephrolithotomy (PNL) using absorbable gelatin sponge as an adjunct. METHODS From January 2004 to March 2009, 45 patients underwent totally tubeless PNL (no internal drainage either with double J stent or ureteric catheter). Inclusion criteria were no significant bleeding from the nephrostomy tract or injury to the pelvicalyceal system (PCS), single nephrostomy tract, infra-costal puncture and complete clearance on fluoroscopy. Median stone size was 3cm (longest diameter recorded). The PNL tract was plugged with absorbable gelatin sponge at the end of the procedure. Drop in hematocrit, hospital stay, pain score by visual analogue scale, urinary leak and perirenal collection by ultrasonography were documented in all the patients. RESULTS Median age was 32 years (range 18-57 yrs). Median size of the stone (largest dimension was taken into consideration)was 3cm (1.8 to 4cm). All patients had complete stone clearance on postoperative X-ray KUB. Drop in mean haematocrit value recorded was 2.4% and none of the patients required blood transfusion. Median pain score was 3. Median value for oral and intravenous Diclofenac sodium was 200mg (150 mg-300mg). Perinephric collection was recorded in 3 patients who were managed conservatively. Median hospital stay was 3 days (2-5 days). CONCLUSION Totally tubeless PNL using absorbable gelatin sponge as sealant of percutaneous nephrostomy tract appears to be safe and effective in select group of patients.