The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy

Tubeless percutaneous nephrolithotomy (PCNL) is a viable option for selected patients, particularly those with solitary calculi, multiple stones located in a single location, or those that can be accessed using one access tract. Benefits over the standard PCNL include reduced hospital stay, decreased pain, and decreased urine leak from the access site that would typically occur from around the nephrostomy tube. Hemostatic agents in the form of fibrin "glue" or gelatin matrix substances have been demonstrated to be safe and effective to augment the tubeless procedure. The most appropriate sealant agent available is yet to be determined. We present a review of the contemporary literature on the use of hemostatic agents for tubeless PCNL.