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Gupta NK, Huda NA, Pal DK. A comparative study between one step dilatation and serial dilatation technique in percutaneous nephrolithotomy. Urologia 2024; 91:332-336. [PMID: 37776272 DOI: 10.1177/03915603231202839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is the first line treatment for treating kidney stones larger than 2 cm size with the advantages of lower morbidity and faster post-operative recovery. Creation of a nephrostomy access is one of the major steps of PCNL. It can be done either by single-step dilatation or by multi-step serial dilatation technique. OBJECTIVES To compare the outcome and evaluate the efficacy of percutaneous nephrolithotomy done by single-step versus serial dilatation technique with specific reference to access time, fluoroscopy time, rate of blood transfusion, length of hospital stay (post-op) and complication rate. METHODS It was a prospective study with a sample size of 100 where 50 patients underwent one-step dilatation and other 50 patients underwent serial-dilatation technique. These patients were analysed on the basis of their demographic profile, renal access time, total fluoroscopy time for access, post-operative haematuria, duration of post-operative hospital stay and complications after operative procedure. Data was analysed and reported using statistical tools. RESULTS Demographic profile of the patients and stone characteristics were equivalent between two groups. Mean access tract dilatation time, mean total fluoroscopy time were significantly less in one of the groups. Requirement of blood transfusion, and post-operative complications rate were not significant between two groups. CONCLUSION Both methods are safe and effective for tract dilatation. However, PCNL can be successfully performed by one-step dilatation with the added advantages of lesser time of renal access, lesser radiation exposure. Blood loss and hospital stay after operative procedure were not statistically significant between two groups.
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Affiliation(s)
- Naveen Kumar Gupta
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Noushim Akram Huda
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
| | - Dilip Kumar Pal
- Department of Urology, IPGME&R and SSKM Hospital, Kolkata, West Bengal, India
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Memik O, Voyvoda B, Ustuner M, Karsli O, Halat AO, Ozcan L. What is the safe and effective dilator number during access in PCNL? Three-shot dilation versus classical sequential Amplatz dilation. BMC Urol 2023; 23:197. [PMID: 38031043 PMCID: PMC10687924 DOI: 10.1186/s12894-023-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Although PCNL has been used for a long time to treat nephrolithiasis, there is still contradictory information concerning the use of the dilation method. In this study, we aimed to compare conventional sequential Amplatz dilatation (SAD) using ten dilators and a method using three dilators (12, 20, and 30 Fr), which we named "three-shot dilatation" (3SD), in terms of fluoroscopy time (FT), operation time, bleeding and stone-free rates. METHODS The study included patients who underwent PCNL with the SAD and 3SD methods. A different surgeon with extensive endourology experience applied each technique. One of the surgeons operated on the patients using the SAD method with ten dilators, and the other surgeon performed the operations using the 3SD method involving three Amplatz dilators (12, 20, and 30 Fr). RESULTS A total of 283 patients, 138 in the 3SD group and 145 in the SAD group, were included in the study. The mean age of the patients was 47.32 ± 13.71 years. There was no statistically significant difference between the two groups regarding preoperative characteristics (p > 0.05). The FTs of access 2, total access, and total operation were significantly shorter in the 3SD group (p = 0.0001). The decrease in hemoglobin was statistically significant in the 3SD group compared to the SAD group (p = 0.022), while the blood transfusion requirements of the groups were similar (p = 0.176). There was no statistically significant difference between the two groups regarding stone-free rates (p = 0.973). In four patients in the SAD group, re-access was necessary due to the loss of passage due to the guide wire slipping out of its place. CONCLUSION Intraoperative FT can be shortened using the described 3SD method without compromising surgical safety. However, this method can be used as an intermediate step in the transition to one-shot dilation by surgeons experienced in performing SAD.
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Affiliation(s)
- Omur Memik
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey.
| | - Bekir Voyvoda
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Murat Ustuner
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Onur Karsli
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Ahmed Omer Halat
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Levent Ozcan
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Dou Q, Qin Z, Liu J, Li R, Jia R. Endoscopic dilation using two guidewires: a novel approach for establishing access tract during percutaneous nephrolithotomy under ultrasonographic guidance. J Int Med Res 2023; 51:3000605231213228. [PMID: 38008900 PMCID: PMC10683570 DOI: 10.1177/03000605231213228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/23/2023] [Indexed: 11/28/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of a novel endoscopic dilation (END) method during percutaneous nephrolithotomy under ultrasonographic guidance. METHODS We retrospectively reviewed the clinical records of 138 patients who underwent percutaneous nephrolithotomy from June 2020 to December 2021. The patients were divided into three groups based on the method of nephrostomy tract creation: those who underwent fascial Amplatz serial fascial dilation (AMD) (n = 45), one-shot dilation (OSD) (n = 45), and END (n = 48). For END, a 20-Fr dilator with sheath was accessed over the first guidewire. A second guidewire was inserted into the collecting system via the endoscope. The nephroscope was then accessed to enlarge the renal puncture point using both guidewires. Demographic variables and important intraoperative and postoperative findings were compared among the three groups. RESULTS The preoperative characteristics were similar among the three groups. The END group had a significantly shorter access time than both the AMD and OSD groups and significantly less severe hemoglobin loss than the OSD group. There were no significant differences in the other important perioperative findings. CONCLUSION Use of this novel END method with two guidewires may be associated with less blood loss and a reduced access time.
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Affiliation(s)
| | | | - Jingyu Liu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Rongfei Li
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Percutaneous Nephrolithotripsy in Morbidly Obese Patient: A Case Report. Case Rep Urol 2022; 2022:5899896. [PMID: 36624815 PMCID: PMC9825217 DOI: 10.1155/2022/5899896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 01/02/2023] Open
Abstract
A 50-year old male patient with morbid obesity was admitted for removal of large staghorn calculi and multiple small stones in the left kidney. The patient was managed by Percutaneous Nephrolithotomy (PCNL). Surgery was carried out in prone position and Alken's metal dilators were used for tract dilation. Alken dilators were inserted without any challenges, and the procedure was completed in a shorter span of time than anticipated with total operative time of 2 hours, including the change of positioning from lithotomy to prone. No intra-operative or post-operative complications were encountered. The patient has been followed up for 6 months post-operatively, without any complications or any evidence of stone recurrence.
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Fahmy A, Mahfouz W, Elbadry M, Moussa A. Single step track dilatation for percutaneous nephrolithotomy in children. Int Urol Nephrol 2022; 54:2789-2795. [PMID: 35941301 PMCID: PMC9534808 DOI: 10.1007/s11255-022-03314-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
Introduction and objectives Data on the use of single step dilatation technique during pediatric percutaneous nephrolithotomy (PCNL) in the literature is sparse. In this prospective randomized study, we aimed to compare the safety, efficacy, and perioperative complications of single step versus serial tract dilatation using Alken metal telescopic dilators during pediatric PCNL. Methods Patients undergoing PCNL were randomized into two groups according to the dilatation technique used. In group A, Alken telescopic serial metal dilatation was utilized, and in group B, single step dilatation was performed. Inclusion criteria included children < 18 years with stone burden from 2 to 4 cm, located in the renal pelvis ± one calyx, who were candidates for PCNL. The primary outcomes were access time and complications’ rate. The secondary outcomes were dilatation fluoroscopy time, operative duration, stone free rate, postoperative hospital stay, hemoglobin deficit, and need for blood transfusion. Both outcomes were evaluated and compared between both treatment groups. Results A total of 70 patients were randomized into group A (35 patients) and group B (35 patients). Access was successfully obtained in all procedures. All the procedures were performed through a single tract. Access time and dilatation fluoroscopy time were shorter in group B (statistically significant). Patients in group A had higher rate of complications (statistically significant). Intraoperative bleeding requiring blood transfusion was less in single track dilatation than serial metal track dilatation. Conclusions Compared to serial metal track dilatation, single step dilatation showed comparable operative time and stone free rate, with significantly reduced access time and dilatation fluoroscopy time.
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Affiliation(s)
- Ahmed Fahmy
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Wally Mahfouz
- Urology Department, Alexandria University, Alexandria, Egypt
| | | | - Ahmed Moussa
- Urology Department, Alexandria University, Alexandria, Egypt
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Srivastava A, Yadav KK, Singh A, Srivastava AK, Singh SK. Feasibility of one-shot dilation access in the pediatric age group. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000311. [DOI: 10.1136/wjps-2021-000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo compare sequential fascial dilation (SFD) versus one-shot dilation (OSD) in the pediatric patients undergoing percutaneous nephrolithotomy.MethodsThe present study is an observational study. The study subjects were divided into two groups. In group 1, renal dilation was done using the SFD and in group 2, renal dilation was done using the OSD. The amount of time exposed to radiation during access to pelvicalyceal system was estimated. Complications, stone free rates, ancillary procedures for residual stones and hospital stay were compared. Modified Clavien-Dindo classification was used for grading the complications.ResultsRadiation exposure and operative time were less in OSD group (95% confidence interval (CI) 3.068 to 14.072, and 2.565 to 12.435, p<0.005). The mean drop of hematocrit was statistically less significant in OSD group (p=0.032). In both groups, complications, stone free rate and hospital stay were statistically insignificant.ConclusionsOSD is feasible in the children with reduced radiation exposure and shorter operative time. The outcome was similar to SFD.
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Peng PX, Lai SC, Seery S, He YH, Zhao H, Wang XM, Zhang G. Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis. BMJ Open 2020; 10:e035943. [PMID: 32660949 PMCID: PMC7359382 DOI: 10.1136/bmjopen-2019-035943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To compare the safety and efficacy of balloon and Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy (PCNL). METHOD EMBASE, PUBMED, MEDLINE and the Cochrane Central Register of Controlled Trials were searched for pertinent studies up until 30 October 2019. Pooled effects were calculated as ORs with 95% CIs or mean differences (MD) with 95% CIs. Endpoints included postoperative decrease in haemoglobin, transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, access time, total operation time and length of postoperative hospitalisation (LPH). Bonferroni's correction was intercalated to reduce the likelihood of making a meta-analytical false positive. RESULTS One randomised controlled trial and five controlled clinical trials were included, which involved 1317 patients in total. We found a lower drop in postoperative haemoglobin for patients receiving balloon dilation compared with those in the Amplatz group (MD=-0.21, 95% CI -0.33 to 0.09, p=0.0005; Bonferroni correction a=0.005). Access time in the balloon group was also, on average, 2.61 min shorter than the Amplatz group (MD=-2.61, 95% CI -4.20 to 1.01, p=0.001; Bonferroni correction a=0.005). No significant differences were identified between the two dilation methods in terms of transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, total operation time and LPH. CONCLUSION Balloon dilation is a safe and effective tract dilation technique for access creation during fluoroscopically guided PCNL. Both of methods have similar success rates although balloon dilation is associated with significantly less postoperative haemoglobin decline and shorter access time. Therefore, balloon dilation appears to be the superior tract dilation technique, but further confirmatory research is required to confirm these findings.
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Affiliation(s)
- Pan-Xin Peng
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Shi-Cong Lai
- Department of Urology, Beijing Hospital; National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Graduate School of Peking, Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Samuel Seery
- School of Humanities and Social Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu-Hui He
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Hang Zhao
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Xu-Ming Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- School of Clinical Medicine, China-Japan Friendship Hospital, Peking University, Beijing, China
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Chiancone F, Meccariello C, Fedelini M, Giannella R, Fedelini P. Four dilation techniques in percutaneous nephrolithotomy: a single-institute comparative analysis. Minerva Urol Nephrol 2020; 73:253-259. [PMID: 32638574 DOI: 10.23736/s2724-6051.20.03836-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare four renal access techniques in percutaneous nephrolithotomy (PCNL). METHODS A total of 437 patients who underwent PCNL at our center from January 2015 to December 2019 were included in the analysis. Telescopic metallic coaxial dilation (TMD) was used in 146 patients, single step balloon dilation (BD) in 98 patients, one-shot dilation with 30F Amplatz (OS 30F) in 106 patients, and one-shot dilation with 16F Amplatz (OS 16F) in 87 patients. Primary endpoints were perioperative outcomes and complications of the procedures. RESULTS Similar baseline characteristics were observed in the four groups. Fluoroscopy time was significantly shorter in OS 30F and OS 16F groups (P<0.0001). The drop in hemoglobin level was not significantly different between TMD and BD groups, but it was significantly lower in OS 16F group versus the OS 30F group and lower in OS 30F group versus the BD Group (P<0.0001). Despite this, the rate of blood transfusion was similar across groups (P=0.837). Moreover, a smaller tract was associated with reduced postoperative morbidity including time to nephrostomy removal (P=0.001), hospital stay (P<0.0001), VAS scale (P<0.0001). There were no significant differences in postoperative complications (P=0.683), and Clavien-Dindo grade ≥3 complication rates (P=0.486) among the groups. Stone-free rates and number of auxiliary procedures required to achieve stone-free status were also similar among all groups (P=0.964 and 0.988, respectively). Multinomial logistic regression analysis showed that BMI (P=0.002), stone size (P=0.002) and previous PCNL (P=0.038) were predictive factors associated with the choice of OS 16 approach. CONCLUSIONS Different dilation methods are equally effective and safe to use in a PCNL procedure for kidney stone treatment, allowing similar stone free rates and risk of complications. The OS dilation techniques seem to allow a shorter X-ray exposure time, which might be beneficial for both patients and operators. The use of a 16 F dilator can reduce the postoperative morbidity. Risk of sepsis should be always kept in mind.
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Affiliation(s)
| | | | | | | | - Paolo Fedelini
- Department of Urology, A.O.R.N. Antonio Cardarelli, Naples, Italy
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Jin W, Song Y, Fei X. The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous Nephrolithotomy. BMC Urol 2020; 20:82. [PMID: 32611424 PMCID: PMC7329447 DOI: 10.1186/s12894-020-00654-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the feasibility and safety of balloon dilation (BD) in totally ultrasound-guided percutaneous nephrolithotomy (PCNL). Methods The data of 95 patients underwent BD were collected in this retrospective study between August 2016 and December 2018. During the same period, telescopic metal dilation was used in 1161 patients. Ninety five patients were selected as the control group and matched at a 1:1 ratio to index balloon dilation (BD) cases in regards to Guy’s stone score, age, sex, BMI, degree of hydronephrosis and stone area. Peri-operative data were compared between the two groups. Results Total operative time was significantly shorter in the BD group (62.2 ± 22.4 min vs. 70.2 ± 25.8 min, p = 0.024). Tract establishment time was significantly shorter in the BD group (3.4 ± 1.8 min vs. 4.3 ± 2.3 min, p < 0.001). The success rate of tract dilation by first attempt was higher in the TMD group compared with that of BD group; however the difference was not statistically significant. There was no significant difference between groups with regards to complication and stone-free rates. The cost of PCNL in the BD group was significantly higher than that of the TMD group (US $4831.4 ± 1114.8 vs. US $4328.4 ± 975.7, p = 0.012). Subsequent analysis revealed that mild or no hydronephrosis were risk factor for failure of balloon dilation under ultrasound. Conclusions BD has acceptable complication and stone free rates compared with those in TMD; however, BD under ultrasound is not suggested for stone cases without hydronephrosis.
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Affiliation(s)
- Wei Jin
- Urology Department, Sheng Jing Hospital of China Medical University, Shenyang, 110000, China
| | - Yan Song
- Urology Department, Sheng Jing Hospital of China Medical University, Shenyang, 110000, China.
| | - Xiang Fei
- Urology Department, Sheng Jing Hospital of China Medical University, Shenyang, 110000, China
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Wu Y, Xun Y, Lu Y, Hu H, Qin B, Wang S. Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta-analysis. Exp Ther Med 2020; 19:2661-2671. [PMID: 32256747 PMCID: PMC7086190 DOI: 10.3892/etm.2020.8486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 01/06/2020] [Indexed: 11/06/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) has become a routine surgical procedure for treating patients with large kidney stones; the fundamental step in this process is the creation of the nephrostomy tract. In the present study, a meta-analysis was performed to compare the effectiveness and safety of different tract dilation techniques for PCNL. Databases were searched from inception to 1 April 2019 to identify relevant randomized controlled trials. The X-ray exposure time, hemoglobin decrease, stone-free rate, transfusion rate, hospital stay and the complication rate associated with the various techniques were analyzed. A total of 11 studies comprising 1,415 cases were enrolled in the meta-analysis. Significant differences in X-ray exposure time [weighted mean difference (WMD), 30.67; 95% confidence interval (CI), 20.08-41.26; P<0.001] and hemoglobin decrease (WMD, 0.19; 95%CI, 0.15-0.23; P<0.001) were identified between metal telescopic dilation (MTD) and one-shot dilation (OSD). A significantly lower hemoglobin decrease was observed in the balloon dilation (BD) vs. fascial Amplatz dilation (AD) group [WMD, -0.65; 95%CI, -(0.77-0.52); P<0.001]. The transfusion rate was similar between these techniques. The MTD had an obviously higher successful dilation rate compared with that of the OSD, but no significant differences in stone-free rate and transfusion rate were obtained. The present study determined that, compared with other methods, OSD was safer in almost every adult patient, including those that had previously undergone renal surgery; though it is recommended that this should be performed by experienced surgeons. BD was reported to be effective and safer in patients without a history of renal surgery compared to other methods. The present study proposed AD and MTD as safer methods of dilation for patients who have previously undergone kidney surgery.
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Affiliation(s)
- Yue Wu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yang Xun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yuchao Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Henglong Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Baolong Qin
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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11
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Peng PX, Lai SC, Ding ZS, He YH, Zhou LH, Wang XM, Zhang G. One-shot dilation versus serial dilation technique for access in percutaneous nephrolithotomy: a systematic review and meta-analysis. BMJ Open 2019; 9:e025871. [PMID: 31005926 PMCID: PMC6500327 DOI: 10.1136/bmjopen-2018-025871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review the outcomes of the use of one-shot dilation (OSD) and serial tract dilation for percutaneous nephrolithotomy (PCNL). METHODS A systematic review and meta-analysis was conducted. The randomised controlled trials (RCTs) included in the study were identified from EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials. The last search was performed on 30 April 2018. Summary effects were calculated as risk ratios (RRs) with 95% CIs or mean differences (MDs) with 95% CIs. The endpoints included access time, fluoroscopy time, successful dilation rate, stone-free rate, postoperative decrease in haemoglobin levels, transfusion rate, complication rate and length of postoperative hospital stay. RESULTS A total of seven RCTs were included in the study, with clinical data reported for 697 patients. The overall access time was approximately 110 s shorter in the OSD group than in the serial dilation group (MD, -110.14; 95% CI -161.99 to -58.30; p<0.0001). The fluoroscopy time was shorter with OSD in all RCTs. In addition, the decrease in postoperative haemoglobin levels was approximately 2.3g/L less in patients in the OSD group than in those in the serial dilation group (MD, -0.23; 95% CI-0.39 to -0.07; p=0.004). No relationship was found between the successful dilation rate, stone-free rate, transfusion rate, or complication rate and the method of tract dilation. CONCLUSION OSD is a safe and efficacious tract dilation technique that can reduce the access time, fluoroscopy time and postoperative decrease in haemoglobin level. No difference was found in the successful dilation rate, stone-free rate, transfusion rate or rate of complications between the OSD and serial dilation groups. The difference in the length of postoperative hospital stay was uncertain. OSD may be a better method of tract creation for PCNL.
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Affiliation(s)
- Pan-xin Peng
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Shi-cong Lai
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Zhen-shan Ding
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Yu-hui He
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Li-hua Zhou
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Xu-ming Wang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Guan Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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12
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Bayne DB, Chi TL. Assessing Cost-Effectiveness of New Technologies in Stone Management. Urol Clin North Am 2019; 46:303-313. [PMID: 30961862 DOI: 10.1016/j.ucl.2018.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.
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Affiliation(s)
- David B Bayne
- Urology, University of California San Francisco, San Francisco, CA, USA.
| | - Thomas L Chi
- Urology, University of California San Francisco, San Francisco, CA, USA
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Chang YL, Chiang PH, Cheng YT, Lee WC. Tract creation using plasma vaporization versus metal dilatation in percutaneous nephrolithotomy: A propensity score-matched analysis. Int J Urol 2018; 26:223-228. [PMID: 30430662 DOI: 10.1111/iju.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To share our 10-year experience of tract creation by using plasma vaporization compared with metal dilatation in percutaneous nephrolithotomy. METHODS We retrospectively reviewed the medical records of 230 patients who had undergone 244 percutaneous nephrolithotomy procedures at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, from January 2007 to December 2016, and divided the patients into the plasma (n = 130) and metal (n = 114) groups. All patients underwent percutaneous nephrolithotomy by either a bipolar resectoscope mounted with a plasma vaporization button electrode or metal dilatation for tract creation. Propensity score matching was applied to reduce selection bias. Perioperative and postoperative data analysis included procedure time, length of hospital stay, blood transfusion rate, any early and late complications, stone-free rate, renal function, and time of need for pain control. RESULTS Before propensity score matching, there were significantly shorter hospital stay (2.6 vs 3.8 days, P < 0.01), less operating time (66.1 vs 108.1 min, P < 0.01) and no blood transfusion rate (0 vs 4 [3.5%], P = 0.031) in the plasma vaporization group. After propensity score matching, there was no statistically significant difference in the patients' baseline characteristics. There were significantly shorter hospital stay (odds ratio 0.46, 95% confidence interval 0.32-0.66; P < 0.001) and shorter average operating time (odds ratio 0.98, 95% confidence interval 0.97-0.99, P < 0.001) in the plasma vaporization group. CONCLUSIONS In comparison with metal dilatation, the plasma vaporization technique is a safe and effective method for creating the nephrostomy tract for percutaneous nephrolithotomy, based on shorter postoperative stay, less operating time, zero blood transfusion rate, acceptable stone-free rate and no major complications.
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Affiliation(s)
- Yin-Lun Chang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Hui Chiang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yuan-Tso Cheng
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chia Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Bryniarski P, Stelmach P, Taborowski P, Rajwa P, Adamkiewicz M, Życzkowski M, Paradysz A. Percutaneous Nephrolithotomy with Amplatz and Alken Dilators: An Eight-Year Single Tertiary Care Centre Experience. Med Sci Monit 2016; 22:4918-4923. [PMID: 27973459 PMCID: PMC5179233 DOI: 10.12659/msm.902163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Percutaneous nephrolithotomy (PNL) is the standard procedure for patients with renal stones over 2 cm in diameter. We analyzed complications after this procedure focusing on two different methods of tract dilation. Material/Methods Between August 2008 and April 2016 222 percutaneous nephrolithotomies were performed in a total of 208 patients. The Group I (n=123) comprised patients where Alken dilatators were used, while Group II (n=99) comprised patients where Amplatz dilators were used. Efficacy was examined based on ultrasound and x-ray examination one month after the procedure. Complications were recorded using Clavien Dindo classification. Results Efficacy was 85.3% and 86.8% in group I and II, respectively (p=0.77). Grade I complications were present in 14.6% and 3%, grade II were present in 9.7% and 8%, grade IIIa were present in 2.4% and 2%, grade IIIb were present in 1.6% and 2%, grade IVa were present in 1.6% and 7%, grade IVb were present in 3.2% and 1% in Group I and Group II, respectively. These differences were statistically significant (p=0.03). Conclusions Efficacy was comparable between Alken dilator and Amplatz dilator groups. In group I, there were more postoperative fevers >38.5 °C and a higher rate of urosepsis. On the other hand, in group II we observed more pleural injuries. All differences resulted from the type of access to the kidney (inter/infracostal), punctured calyx, and utilization (or not) of access sheath rather than type of dilators itself.
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Affiliation(s)
- Piotr Bryniarski
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Paweł Stelmach
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Piotr Taborowski
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Mateusz Adamkiewicz
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Marcin Życzkowski
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia in Katowice, Zabrze, Poland
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15
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Yang L, Lu S, Han X, Wei P, Yang J, Hao T. Clinical comparison of the efficiency and security of balloon dilators versus fascial dilators in percutaneous nephrolithotripsy (PCNL). Pak J Med Sci 2016; 32:635-40. [PMID: 27375705 PMCID: PMC4928414 DOI: 10.12669/pjms.323.9281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the efficiency and security of the balloon dilators versus fascial dilators in percutaneous nephrolithotripsy (PCNL), We compared the difference of intraoperative and postoperative parameters of patients using these two different methods of expansion and having no significant statistic differences in peroperative parameters. METHODS This is a retrospective analysis of 134 patients undergoing PCNL with upper urinary calculi from January 2012 to January 2014 in Luoyang Central Hospital affiliated to Zhengzhou University. These patients meeting the inclusion criteria were divided into two groups: the group of balloon dilators (group A) and the group of fascial dilators (group B). Two groups were compared for success rate of first expansion, clearance of stone, duration of surgery, intraoperative hemorrhage, blood transfusion rate, postoperative hospitalization and the incidence of complications. RESULT In Group A, a total of 91 patients (51 men and 40 women, mean age 51.22±8.96 years, ranged from 28 to 68 years, the calculi maximum diameter from 0.9 to 4.5cm, 28 cases with a history of gravel, mean Body mass index 24.20±2.34, 73 cases with hydronephrosis and 26 cases with underlying diseases such as hypertension, diabetes and the like) undergoing PCNL were retrospectively reviewed. Similarly, In Group B, a total of 43 patients (28 men and 15 women, mean age 49.64±10.62 years, ranged from 15 to 70 years, the calculi maximum diameter from 1.1 to 5.2cm, 18 cases with a history of gravel, mean Body mass index 24.40±2.70, 38 cases with hydronephrosis and 14 cases with underlying diseases such as hypertension, diabetes and the like) undergoing PCNL were retrospectively reviewed. Our results showed that there was a statistically significant better outcome in Group A than in Group B in terms of success rate of first exploration, duration of operation, intraoperative hemorrhage, postoperative hospitalization and the incidence of complications. Additionally, there was no statistically significant difference with respect to clearance of stone and incidence of blood transfusion in the two groups. CONCLUSION Balloon dilators had shorter operation time, less bleeding, higher success rate of first expansion, less postoperative complications and shorter postoperative hospitalization than fascial dilators in PCNL.
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Affiliation(s)
- Lingbo Yang
- Prof. Lingbo Yang, MD. Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
| | - Shuaiqi Lu
- Prof. Shuaiqi Lu, MM. Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
| | - Xingtao Han
- Prof. Xingtao Han, MD Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
| | - Pengtao Wei
- Prof. Pengtao Wei, MD. Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
| | - Jinhui Yang
- Dr. Jinhui Yang, MM. Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
| | - Tongtong Hao
- Dr. Tongtong Hao, MM. Department of Urology, Luoyang Central Hospital affliliated to Zhengzhou University, 471000, Luoyang, China
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Nalbant I, Karakoyunlu AN, Yesil S, Ekici M, Zengin K, Ozturk U, Imamoğlu MA. Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful? J Laparoendosc Adv Surg Tech A 2016; 26:478-82. [PMID: 27027932 DOI: 10.1089/lap.2015.0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ismail Nalbant
- Clinics of Urology, Diskapi Training and Research Hospital, Ankara, Turkey
| | | | - Suleyman Yesil
- Clinics of Urology, Medical Faculty, Gazi University, Ankara, Turkey
| | - Musa Ekici
- Clinics of Urology, Medical Faculty, Hitit University, Corum, Turkey
| | - Kursad Zengin
- Clinics of Urology, Medical Faculty, Bozok University, Yozgat, Turkey
| | - Ufuk Ozturk
- Clinics of Urology, Diskapi Training and Research Hospital, Ankara, Turkey
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Hijazi S, Echtle D, Hasselhof VM, Trojan L, Heinrich E. Metal telescopic and Amplatz sheath dilation in nephrolithotomy. Urol Ann 2016; 8:66-9. [PMID: 26834405 PMCID: PMC4719516 DOI: 10.4103/0974-7796.163795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Comparison of Amplatz sheath percutaneous nephrolithotomy (Amplatz PCNL) and metal telescopic dilation PCNL (MTD PCNL) with respect to clinical outcomes and complications. MATERIALS AND METHODS Single-institution retrospective chart review with 73 patients who underwent PCNL divided into two groups: Amplatz PCNL (n = 26) and MTD PCNL (n = 47). Efficacy (stone-free rate, residual stones, and surgical duration) and safety (transfusion rate and hemoglobin decrease) were evaluated. Complications were recorded and classified using the modified Clavien classification system. RESULTS The two PCNL groups were similar regarding mean age, stone burden, side, stone location, and stone composition. There were no significant differences in surgery duration (101 ± 28 vs. 98 ± 30 min; P = 0.906), transfusion rate (3.9% vs. 4.3%; P = 0.382), and hemoglobin drop (0.9 ± 0.9 vs. 1 ± 0.7 g/dl; P = 0.424) for Amplatz and MTD PCNL, respectively. Stone-free rate (86% vs. 68%; P = 0.001) was significantly higher while residual fragments rate (37% vs. 60%; P = 0.001) was significantly lower in Amplatz PCNL compared to MTD PCNL. However, tube stay time (4.4 ± 1.8 vs. 5.8 ± 3.6 days; P = 0.005) and hospital time (8.6 ± 2.6 vs. 9.7 ± 5.5 days; P = 0.0001) were significantly longer in Amplatz PCNL compared to MTD PCNL. Clavien grading revealed a significantly higher rate of low-grade complications (I-III) for the MTD PCNL in comparison to Amplatz PCNL (10.6% vs. 3.9%, respectively; P = 0.011). There were no major complications and no tract dilation failure. CONCLUSION The study demonstrates that Amplatz PCNL is a safe and effective procedure to remove large renal stones compared with MTD PCNL.
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Affiliation(s)
- Sameh Hijazi
- Department of Urology, University Medical Center Goettingen, Göttingen, Germany
| | - Dieter Echtle
- Department of Urology, Staetische Kliniken Moenchengladbach, Mönchengladbach, Germany
| | | | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Göttingen, Germany
| | - Elmar Heinrich
- Department of Urology, University Medical Center Goettingen, Göttingen, Germany
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Karakoyunlu N, Goktug G, Şener NC, Zengin K, Nalbant I, Ozturk U, Ozok U, Imamoglu A. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study. Urolithiasis 2015; 43:283-7. [DOI: 10.1007/s00240-015-0768-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
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Sharma GR, Maheshwari PN, Sharma AG, Maheshwari RP, Heda RS, Maheshwari SP. Fluoroscopy guided percutaneous renal access in prone position. World J Clin Cases 2015; 3:245-264. [PMID: 25789297 PMCID: PMC4360496 DOI: 10.12998/wjcc.v3.i3.245] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/24/2014] [Accepted: 12/01/2014] [Indexed: 02/05/2023] Open
Abstract
Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access.
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20
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A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. BIOMED RESEARCH INTERNATIONAL 2014; 2014:691946. [PMID: 25295266 PMCID: PMC4177728 DOI: 10.1155/2014/691946] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 08/21/2014] [Indexed: 11/26/2022]
Abstract
Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.
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21
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Nour HH, Kamal AM, Zayed AS, Refaat H, Badawy MH, El-Leithy TR. Single-step renal dilatation in percutaneous nephrolithotomy: A prospective randomised study. Arab J Urol 2014; 12:219-22. [PMID: 26019953 PMCID: PMC4435660 DOI: 10.1016/j.aju.2014.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/02/2014] [Accepted: 06/08/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To perform an economical single-step renal dilatation (RD) during percutaneous nephrolithotomy (PCNL), using directly a 30-F Amplatz dilator over the central Alken dilator, in a trial to reduce the operative duration and radiation exposure during RD while avoiding an exchange of dilators that might increase the risk of blood loss. Patients and methods In a prospective randomised study including 49 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. Results The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P < 0.05). There were perioperative complications, according to the Clavien grading system, in 17 (34%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. Conclusion A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD.
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Affiliation(s)
- Hani H Nour
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
| | - Ahmad M Kamal
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
| | - Ahmad S Zayed
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
| | - Hisham Refaat
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
| | - Mohamed H Badawy
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
| | - Tarek R El-Leithy
- Department of Urology, Theodor Bilharz Research Institute, Guiza, Egypt
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Özçift B, Bal K, Dinçel Ç. A comparison of balloon and amplatz dilators in percutaneous nephrolithotomy: a retrospective evaluation. Turk J Urol 2013; 39:226-31. [PMID: 26328115 DOI: 10.5152/tud.2013.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 05/17/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In this study, we compared our experience using balloon and amplatz dilatation in percutaneous nephrolithotomy (PCNL). We also evaluated peri- and postoperative variables, including success rates. MATERIAL AND METHODS Two hundred renal stone patients (123 men/77 women) underwent PCNL at the Urology Clinic of İzmir Atatürk Training and Research Hospital from September 2005 to May 2011. The nephrostomy tract was dilated using a balloon (128 patients) or amplatz (72 patients) dilator. The groups were compared by age, total operating time, treatment success rate, retreatment rate, pre- and postoperative hematocrit values, mean decrease in hematocrit values, blood transfusion rate, stone burden, tract dilatation failure, hospital stay and nephrostomy removal times, stone localization, previous stone operation and the cost of the dilatation system. RESULTS There was no statistically significant difference in the operative time (97.9±45.3 minutes in balloon group vs. 98.5±43.4 minutes in the amplatz group; p=0.43), preoperative hematocrit value (39.04±4.21 vs. 38.94±4.49; p=0.87), postoperative hematocrit value (32.74±4.86 vs. 32.48±5.43; p=0.73), decrease in hematocrit values (6.30±2.60 vs. 6.45±2.64; p=0.68), blood transfusion rate (15.6% vs. 16.7%; p=0.84) or treatment success rate (78.9% vs. 79.2%; p=0.96) between balloon and amplatz groups. Differences in other variables were also not observed between the two groups. CONCLUSION The balloon or amplatz dilatation methods have similar results with regard to efficacy, speed, and safety. However, the cost of the balloon dilator is higher than that of the amplatz dilator.
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Affiliation(s)
- Burak Özçift
- Department of Urology, Hakkari State Hospital, Hakkari, Turkey
| | - Kaan Bal
- Department of Urology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey
| | - Çetin Dinçel
- Department of Urology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir, Turkey
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A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 2013; 41:523-30. [PMID: 23975408 DOI: 10.1007/s00240-013-0598-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/05/2013] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to evaluate the efficacy and safety of the Amplatz dilation (AD), metal telescopic dilation (MTD), balloon dilation (BD), and one-shot dilation (OSD) methods for tract dilation during percutaneous nephrolithotomy (PCNL). Relevant eligible studies were identified using three electronic databases (Medline, EMBASE, and Cochrane CENTRAL). Database acquisition and quality evaluation were independently performed by two reviewers. Efficacy (stone-free rate, surgical duration, and tract dilatation fluoroscopy time) and safety (transfusion rate and hemoglobin decrease) were evaluated using Review Manager 5.2. Four randomized controlled trials and eight clinical controlled trials involving 6,820 patients met the inclusion criteria. The pooled result from a meta-analysis showed statistically significant differences in tract dilatation fluoroscopy time and hemoglobin decrease between the OSD and MTD groups, which showed comparable stone-free and transfusion rates. Significant differences in transfusion rate were found between the BD and MTD groups. Among patients without previous open renal surgery, those who underwent BD exhibited a lower blood transfusion rate and a shorter surgical duration compared with those who underwent AD. The OSD technique is safer and more efficient than the MTD technique for tract dilation during PCNL, particularly in patients with previous open renal surgery, resulting in a shorter tract dilatation fluoroscopy time and a lesser decrease in hemoglobin. The efficacy and safety of BD are better than AD in patients without previous open renal surgery. The OSD technique should be considered for most patients who undergo PCNL therapy.
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Wang Y, Jiang F, Hou Y, Wang Y, Chen Q, Zhang H, Xu N, Lu Z, Hu J, Wang X, Lu J, Hao Y, Wang C. Doppler ultrasound and X-ray-guided percutaneous nephrolithotomy with one-step balloon dilation for complex renal stones. Urol Int 2013; 91:326-30. [PMID: 23860391 DOI: 10.1159/000350522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 03/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of combining Doppler ultrasound with X-ray-guided percutaneous nephrolithotomy (PCNL) with one-step balloon dilation for management of complex renal stones. MATERIAL AND METHODS We retrospectively analyzed 85 renal stone patients who underwent 89 PCNLs from January 2011 to May 2012. Doppler ultrasound with X-ray-guided PCNL with one-step balloon dilation was finished on the Fluoroscopic Table (Siemens, Berlin, Germany) with the patient under general anesthesia. RESULTS The study included 85 patients (49 male and 36 female) with a mean age of 42.5 ± 16.4 years. All patients underwent 89 PCNLs (4 patients had bilateral stones). The mean operative time was 72.8 min (range: 35-140). The average fluoroscopic screening time was 5.55 ± 1.81 s (range: 4-12). Successful access to the collecting system was 98.9% (88/89). Although most of the cases (85/89) were managed satisfactorily by a single tract, a second tract was used in 4 cases. No severe complications occurred. The stone-free rate of PCNL monotherapy was 77.5% (69/89). At 3 months, the stone-free rate increased to 89.9% (80/89) after shock wave lithotripsy. CONCLUSIONS PCNL with one-step balloon dilation for the management of complex renal stones under the guidance of combining Doppler ultrasound with X-ray is safe and effective because of its high stone-free rate and low operative time.
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Affiliation(s)
- Yanbo Wang
- Department of Urology, First Hospital of Jilin University, Changchun, PR China
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