Tract Closure in PCNL

Defining the Role of Hemostatic Agents in Percutaneous Nephrolithotomy: A Randomized Controlled Trial of Tract Closure Techniques

This is a prospective, randomized controlled trial evaluating the effect of a hemostatic agent on tract-related bleeding during percutaneous nephrolithotomy (PCNL). Patients undergoing standardized PCNL will be randomized to receive either application of a hemostatic agent or no agent during tract closure, following uniform balloon occlusion, complete aspiration, and irrigation-free endoscopic assessment. The researchers hypothesize that adjunctive hemostatic agent use reduces perioperative hemoglobin decline compared with balloon tamponade alone and improves tract-related hemostasis outcomes.

Inclusion criteria:

• At least one stone ≥ 1.2cm
• Scheduled to undergo planned PCNL
• Age ≥ 18 years

Exclusion criteria:

• Unable to provide informed consent
• Pre-existing nephrostomy tube
• Multi access cases
• Stone in calyceal diverticulum/hydrocalyx
• Preoperatively planned overnight admission for any reason
• Infundibular stenosis
• Coagulation disorders
• Other significant anatomic abnormalities