EAU 2017: A Prospective, Randomized Trial Evaluating The Efficacy Of Two Different Hemostatic Sealant In Tubeless Percutaneous Nephrolithotomy

London, England (UroToday.com) Percutaneous nephrolithotomy (PCNL) is a golden standard surgical modality for large kidney stones. Optimal technique for postoperative closure of the surgical tract in yet to be determined. This is important for two reasons, the first is that the access tract may bleed after the removal of surgical instruments and sheath, and the second is that several randomized studies have shown improved patients comfort by not having any nephrostomy tubes after the procedure. Although several retrospective studies have shown advantages to several closure techniques, proper prospective studies lack power to make a conclusion on closure technique selection.

Kim and colleagues presented a prospective, randomized trial to assess the safety and efficacy of Tisseel, Tachosil in patients undergoing tubeless PCNL.
In this Kim and authors prospectively randomized a total of 75 patients undergoing tubeless PCNL. Patients who met the inclusion criteria were randomized to receive Tisseel® (group 1), Tachosil® (group 2) and control (group 3) at the end of the procedure. The hemostatic sealants were placed under direct vision in the nephrostomy tract. The three groups were comparable in age, sex, height, weight, body mass index, stone size and in metabolic and anatomic features. Authors evaluated factors including postoperative blood loss, postoperative pain, length of hospital stay and perirenal hematoma formation.

Study demonstrated that there was no difference in the hemoglobin, hematocrit decrease and blood transfusion requirements among the 3 groups. This is somewhat expected results given the contemporary technology that makes the access safe. Additionally, there was no significant difference in the extent of postoperative perirenal hematoma formation. (p=0.694).

One of the important outcomes after different types of closure techniques is pain assessment in patients immediately and during the follow up after PCNL. Patients were given to complete pain scale and the average visual analog scale pain score on postoperative 1 day was 1.92±2.47, 1.72±1.67 and 1.48±1.73 respectively in each group with no statistical significance (p=0.378). The length of hospital stay was also comparable within each group.

Regarding complications associated with closure technique, authors presented that no long-term sequelae were observed with the median follow up period of 24 months in any patient. Although complications are not expected to occur after 2 months of the procedure, but the long-term data demonstrates that all sealants are safe to use after PCNL.

Authors concluded that the hemostatic agents in standard tubeless PCNL were not expected to be effective or mandatory. Additional wide, prospective, randomized studies are required to get more definitive clinical evidence for the hemostatic agent usage in tubeless PCNL.

Speaker(s): Dr. Kim, MD

Authors: Kim S.H.2, Yoon B.I.3, Choi Y.S.1, Kim K-S.1, Lee K-W.1, Choi S.W.1, Bae W.J.1, Ha U-S.1, Lee J-Y.1, Kim S-W.1, Hong S-H.1, Cho H.J.1

Institution(s): 1The Catholic University of Korea, Seoul St. Mary's Hospital, Dept. of Urology, Seoul, South Korea, 2The Catholic University of Korea, St. Paul’s Hospital, Dept. of Urology, Seoul, South Korea, 3Catholic Kwandong University, International St. Mary’s Hospital, Dept. of Urology, Incheon, South Korea

at the #EAU17 - March 24-28, 2017- London, England