Does sealing of the tract with absorbable gelatin (Spongostan) facilitate tubeless PCNL? A prospective study

Abstract

Purpose: To prospectively evaluate and study the role, relative safety, and efficacy of using absorbable gelatin tissue hemosealant (Spongostan) in patients selected for a gelatin-assisted "tubeless" percutaneous nephrolithotomy (PCNL); to study whether it facilitates and further reduces the morbidity vis-à-vis tubeless PCNL without gelatin; and to compare postoperative pain, analgesia requirement, hospital stay, return to work time, and other parameters in patients undergoing tubeless PCNL with gelatin and tubeless PCNL without the gelatin sealant. In addition, we briefly review various hemosealants used in tubeless PCNL by other workers.

Patients and methods: Fifty selected previously qualified patients underwent tubeless PCNL. All procedures were performed by a single urologist (IS), and a resident administered random chit numbers and recorded pain scores and results of all the chosen parameters. Patients who fulfilled our criteria for tubeless PCNL were randomized to either the placement of a gelatin sealant or its omission. The data were analyzed with respect to several parameters.

Results: The mean age, stone burden, preoperative hemoglobin, blood urea, and serum creatinine values, hematocrit drop, and the time to return to work were not significantly different between the two groups. The hospital stay (P = 0.057), urinary extravasation (P < 0.001), and analgesia requirement (P < 0.001) were significantly lower in the patients who had undergone gelatin-sealant-assisted tubeless PCNL.

Conclusions: Significantly less pain, lower analgesia requirement, and shorter hospital stay with lower wound soakage/discomfort were observed in the gelatin-assisted tubeless PCNL group v tubeless PCNL without gelatin packing. The use of absorbable gelatin sealant is safe, feasible, and a useful adjunct toward a safer tubeless PCNL in patients who previously qualified for tubeless PCNL.