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Objective Tubeless percutaneous nephrolithotomy (PCNL) offers several advantages over standard PCNL, including a shorter hospital stay, less analgesic requirement, and less postoperative pain. Using a fibrin sealant to seal the nephrostomy tract had become a widely accepted technique at the conclusion of tubeless PCNL. Our objective is to evaluate the efficacy and safety of tubeless PCNL using hemostatic matrix. Materials and methods This is a retrospective review of PCNL database at our hospital between June 2014 and March 2016. During this period, a total of 139 PCNLs were performed, including 41 with tubeless technique with adjunct of hemostatic matrix (Floseal; Baxter, Deerfield, IL, USA) at the conclusion of the PCNL procedure. The standard PCNL group and the tubeless PCNL group were compared in terms of demographic characteristics, perioperative data, stone characteristics, and complication rate. Results Of all 123 patients included in this study, 41 underwent tubeless PCNL. Demographic data of the two groups were comparable except for a higher proportion of male patients in the tubeless PCNL group (73.2% vs. 53.7%). Stone characteristics were also comparable in the two groups. Perioperative variables, including operative time, drop of serum hemoglobin level, and perioperative complication rate, revealed no statistical difference between the two groups. Tubeless PCNL was associated with less postoperative pain, less analgesic requirement, and a shorter hospital stay (p Conclusion Tubeless PCNL with adjunct use of a hemostatic sealant can be considered as a safe treatment option for renal calculi with favorable outcome, without an increase in complications. Compared with standard PCNL, tubeless PCNL with hemostatic sealant use is associated with less pain, use of fewer narcotic agents, and a shorter hospital stay.

Purpose: Direct vision internal urethrotomy (DVIU) is the most common surgical intervention for anterior urethral strictures. We evaluated the long-term outcome and success rate of optic urethrotomy in patients treated in our hospital who had recurrent anterior urethral strictures, according to different predisposing causes and stricture sites. The aim is to find the success rate of optic urethrotomy in patients treated who had recurrent anterior urethral strictures. Materials and Methods: This study is a retrospective chart review. From January 2000 to August 2017, 232 patients received internal optic urethrotomy for anterior urethral strictures in our hospital. A retrospective chart review of all patients involved in the study was performed. Median follow-up period after receiving the first urethrotomy procedure was 91 months (range: 8–204 months). The Kaplan–Meier method was used to analyze the success rate of the first, second, third, fourth, and fifth urethrotomy procedures. Results: Of the 232 patients who underwent at least two procedures of urethrotomy, 150 (64.65%) were included in the study. The success rate of the first urethrotomy procedure was 0%, with a mean time to recurrence of 20 months. For the second urethrotomy, the success rate was 53%, with a mean time to recurrence of 22.5 months. For the third urethrotomy, the success rate was 40%, with a mean time to recurrence of 16.1 months. For the fourth and fifth urethrotomy procedures, the success rate was 39% and 18%, with a mean time to recurrence of 17.9 and 10.2 months, respectively. Patients who had anterior urethral stricture related to previous surgery (surgery-related) had a better outcome (success rate, 87.3%) than patients with strictures stemming from other causes (P = 0.003). No association was found between preoperative infection, the age of the patient, and the site of the strictures and the success rate of the procedure. Conclusion: The patient population was older and had a longer-term follow-up, compared with previous studies, but even with repeated DVIU, the surgery-related stricture group had a higher success rate of urethrotomy than the groups with different etiology. In patients with pelvic fracture or infection, repeated urethrotomy may not be recommended as first-line treatment for recurrent anterior urethral stricture.