Pressure compression of the access tract for tubeless percutaneous nephrolithotomy

Purpose: To evaluate the efficacy of access tract tamponade with oxidized regenerated cellulose (Surgicele) for tubeless PCNL.

Materials and Methods: Since April 2013 to June 2014, 216 PCNL was performed at our hospital. After the end of stone extraction, the access tract was cauterized and an 8F Foley catheter was inserted to the renal pelvis through the working sheath then inflated and gently retracted. The working sheath was withdrawn to the renal capsule and the access tract of the renal parenchyma was packed with Surgicele and compressed with small sized dilators through the working sheath for 5 minutes. A bloodless tract usually could be obtained in nearly every patient.

Results: Of the 216 patients, 129 patients were male and 77 patients were female. The age of these 216 patients ranged from 26 to 82 (mean 56.0) years old. The characteristics of the stones were renal stones in 147 patients (36 patients had complete staghorn stones), ureteral stones in 47 patients and kidney with ureteral stones in 23 patients. The average stone size was 3.6 (0.9–10.5) cm and the average operation time was 80.5 (30–200) minutes. The target stones had all been removed and the overall stone free rate was 73.6%. The postoperative blood transfusion rate was 1.3% (3 patients). Postoperative fever was noted in 23 patients (10.6 %) and sepsis was noted in 3 patients (1.4%). The average post operative hospital stay was 3.2 (2–8) days.

Conclusion: Pressure compression is an alternative method to minimized hemorrhage complication for tubeless PCNL.