Tubeless percutaneous nephrolithotomy (PCNL) has been shown to reduce hospital stays and postoperative pain. Prior studies suggest that using a gelatin matrix hemostatic sealant (FloSeal®) to close nephrostomy tracts may lower postoperative morbidity. This study evaluates the safety and efficacy of FloSeal® in tubeless PCNL for patients with complete staghorn stones.

Between January 2017 and December 2022, 665 patients underwent PCNL at our institution, including 78 with complete staghorn stones. Of these, 33 patients received nephrostomy tract closure with FloSeal® following retrograde balloon occlusion. We retrospectively analyzed demographic, intraoperative, and postoperative outcomes.

Patients treated with FloSeal® had significantly shorter postoperative hospital stays (3 vs. 5 days; p < 0.001), lower rates of postoperative blood transfusion (12% vs. 33%; p = 0.036), and fewer postoperative complications (39% vs. 67%; p = 0.017). Postoperative day 1 residual stone size was also smaller in the FloSeal® group (1 cm vs. 1.5 cm; p = 0.033). Although not statistically significant, a higher stone-free rate was observed in the FloSeal® group (24% vs. 13%; p = 0.215).

The use of FloSeal® to seal the nephrostomy tract during tubeless PCNL in patients with complete staghorn stones is associated with reduced bleeding, fewer transfusions, decreased postoperative complications, shorter hospital stays, and smaller residual stone size. Prospective, randomized studies are warranted to further define its clinical benefits.