Search

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]