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Purpose: To evaluate the rate of and predictors of ureteral obstruction after mini-percutaneous nephrolithotomy (mPCNL) for kidney stones. Methods: We analyzed data from 263 consecutive patients who underwent mPCNL at a single tertiary referral academic between 01/2016 and 11/2022. Patient's demographics, stone characteristics, and operative data were collected. A nephrostomy tube was placed as the only exit strategy in each procedure. On postoperative day 2, an antegrade pyelography was performed to assess ureteral canalization. The nephrostomy tube was removed if ureteral canalization was successful. Descriptive statistics and logistic regression models were used to identify factors associated with a lack of ureteral canalization. Results: Overall, median (IQR) age and stone volume were 56 (47-65) years and 1.7 (0.8-4.2) cm3, respectively. Of 263, 55 (20.9%) patients showed ureteral obstruction during pyelography. Patients without ureteral canalization had larger stone volume (p < 0.001), longer operative time (p < 0.01), and higher rate of stones in the renal pelvis (p < 0.01) than those with normal pyelography. Length of stay was longer (p < 0.01), and postoperative complications (p = 0.03) were more frequent in patients without ureteral canalization. Multivariable logistic regression analysis revealed that stone volume (OR 1.1, p = 0.02) and stone located in the renal pelvis (OR 2.2, p = 0.04) were independent predictors of transient ureteral obstruction, after accounting for operative time. Conclusion: One out of five patients showed transient ureteral obstruction after mPCNL. Patients with a higher stone burden and with stones in the renal pelvis are at higher risk of inadequate ureteral canalization. Internal drainage might be considered in these cases to avoid potential complications. [ABSTRACT FROM AUTHOR]

To study the feasibility and safety of One-Shot Dilatation (OSD), versus serial sequential dilatation in tubeless Percutaneous Nephrolithotomy (PCNL). One Hundred and Fifty patients were randomised into two groups; Group A (One-Shot Dilatation), Group B (Serial Dilatation). Twenty-one patients were excluded from the study. Detailed history was taken and full physical examination was performed. Pre-operative routine laboratory investigations were done. Also, non-contrast Computed Tomography of the Urinary Tract (CTUT) and plain urinary tract x-ray were done. Intra-operative assessments of dilatation, total operative, total fluoroscopy and fluoroscopy during dilatation durations were recorded, as well as estimated blood loss. Post-operatively haemoglobin, creatinine levels and CTUT were performed for all patients. Complications, as urinary leakage time, analgesic requirements and hospitalization time were measured. There were statistically significant differences in the intraoperative durations, where Group A had shorter dilatation time, fluoroscopy time during dilatation and total operative time. Group B had a higher complications rate than Group A; 37.9%, 11.3%, respectively. Also, Group B showed haemoglobin drop by 0.44 mg/dl higher than Group A. More doses of analgesia were required for Group B. Hospitalization time and rate of urinary leakage were both in favour of Group A. For patients undergoing Tubeless PCNL, we have concluded that one-shot dilatation seems to be a safer and more feasible technique than Serial dilatation. [ABSTRACT FROM AUTHOR]

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]

Purpose: The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model. Materials and Methods: A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination. Results: The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method. Conclusions: Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the current practice of percutaneous nephrolithotomy (PCNL), conducting a worldwide survey among urologists with a special interest in endo-urology. Methods: A 22-question survey was specifically developed by the European Association of Urology (EAU) young academic urologists (YAU) and uro-technology (ESUT) groups and globally distributed via SurveyMonkey to almost 2000 members of Endourology Society. The questionnaire included questions dedicated to the demographics and general practice of the participating urologists. Results: In total, 441 responses (male/female ratio – 418/23) were received. A comparatively higher percentage of specialists (56.2%) practiced in academic institutions and had specific endo-urological fellowship training (56.7%). The classical prone PCNL remained the most practiced approach among the surveyed specialists, 47.7% stated to always do prone PCNLs, while 51.8% of respondents used multiple positioning options as required. The PCNL tract was mostly performed by urologists (84.3%) and fluoroscopic guidance was still predominantly used by 74.5% of respondents. The most practiced tract dilation method was balloon dilator used by 42% of respondents. Most of the surveyed urologists had ultrasonic, pneumatic or laser lithotripsy devices in their armamentarium. The use of some form of post-procedural drainage was reported in 85.1% of respondents, whereas tubeless PCNL remained a fairly uncommon practice. Conclusion: The majority of urologists still use prone positioning, get their own access under fluoroscopy guidance and use a balloon for tract dilation. However, we also identified that when necessary, urologists will deviate from routine practice and change strategy, adopting other approaches for PCNL. [ABSTRACT FROM AUTHOR]

Copyright of Bosphorus Medical Journal / Boğaziçi Tıp Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Access to the pelvi-calyceal system and subsequent dilatation of the tract are among the initial important steps in percutaneous nephrolithotomy (PCNL). In this study, we share our experience with single-step renal dilatation when compared to multiple serial renal dilatation in PCNL. Materials and Methods: This is a retrospective study wherein 35 patients who underwent PCNL by single-step renal dilatation by appropriate size Amplatz Dilator were compared with 35 patients who underwent multi-step serial renal dilatation using serial metallic Alken dilators. These patients were analyzed on the basis of demographic profile, total intra-operative time, fluoroscopic time, intra-operative and postoperative complications, stone clearance, requirement of blood transfusion, duration of hospital stay, and follow-up. Results: There were no significant differences in the demographic profile among the patients in these two groups. The mean total operative duration and fluoroscopic duration were less in single step renal dilatation group, and these have been found to be statistically significant (P < 0.05). There were no statistically significant differences in the rates of other complications – incomplete stone clearance, bleeding and hematoma formation, requirement of blood transfusion, duration of hospital stay, and follow-up. Conclusion: Operative duration and rate of radiation exposure are significantly less in PCNL by single-step renal dilatation; however, there is no statistically significant difference in the rates of other complications. [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]

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. [ABSTRACT FROM AUTHOR]

Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Percutaneous nephrolithotomy (PCNL) is gold standard technique for the treatment of renal calculi larger than 2 cm or complex renal calculi. Establishment of nephrostomy tract is the important step during PCNL. Hence, this study was conducted to evaluate the effectiveness of single-step dilatation in patients with renal calculi undergoing PCNL. Methods: This is a prospective, single-center study conducted between August 2014 and December 2017. Patient who underwent PCNL using single-step dilatation between the study period were included in the study. Demographic details, stone characteristics, operative time dilatation time, radiation exposure time, rate of complication and blood transfusion were recorded. Data was analyzed and reported using summary statistics. Results: A total of 332 patients were enrolled in this study. The mean (SD) age was 42.46 (15.53) years and 181 (54.52%) patients were male. Overall, stone clearance rate was 92%. The mean (SD) operative time was 62.74 (29.61) minutes, tract dilatation time was 2.18 (1.05) minutes, and the radiation exposure time was 12.68 (6.45) seconds. Blood transfusion was required in 12(3.6%) patients. No major complications were reported during post-operative period. Conclusion: Single-step dilatation technique is safe, economical and feasible technique with added advantage of lesser time of dilatation, lesser radiation exposure and lesser chance of blood transfusion. [ABSTRACT FROM AUTHOR]

The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10F fascial dilator was used to dilate the tract. Subsequently, the 6F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and feasibility of percutaneous tract dilation by the one-stage method in preschool children. Methods: Between April 2009 and February 2013, all preschool (<6 years) children who were candidates for percutaneous nephrolithotomy were enrolled in this prospective study. Patients were randomly assigned to dilation by serial metallic dilators (group I, 31 patients) or dilation by one-stage Amplatz according to Frattini et al. [J Endourol 2001;15:919-923] (group II, 31 patients). The primary endpoint of interest was fluoroscopy time. Secondary endpoints included tract creation and dilation time, success rate and complications. Stone-free status was defined as residuals ≤3 mm. Results: Age, stone size, operation success and operation time were not significantly different between the studied groups. The most common stone composition was calcium oxalate in both groups. The mean ± standard deviation of access and fluoroscopy times in groups I and II were 7.3 ± 1.2 min vs. 5.9 ± 1.5 min (p > 0.05) and 70.0 ± 8.9 s vs. 22.0 ± 5.6 s (p < 0.001), respectively. Postoperative complications included one case of postoperative fever lasting less than 48 h in group I. Conclusions: Percutaneous tract dilation by the one-stage method is safe and effective. Also, it is associated with considerably less radiation exposure in preschool children. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the efficacy and safety of one-shot versus gradual dilation technique for tract creation in percutaneous nephrolithotomy (PCNL). A systematic research of Pubmed, Embase and the Cochrane Library was performed to identify all relevant studies. The quality of the included trials was assessed and the data were extracted independently by two reviewers. The Cochrane Collaboration's Review Manager (RevMan) 5.0.2 software was used for statistical analysis. Four randomized controlled trials were included in analysis involving 346 patients in total. Of these patients 174 were in the one-shot group and 172 in the gradual group. Our meta-analysis showed that there were no significant differences in successful dilation rate [risk ratio (RR): 0.96; 95 % confidence interval (CI): 0.92-1.00, p = 0.05], transfusion rate (RR: 0.62; 95 % CI: 0.20-1.96; p = 0.42), and hemoglobin decrease [mean difference (MD): −0.34; 95 % CI: from −0.67 to −0.00; p = 0.05] between one-shot dilation and gradual dilation. One-shot dilation had significant shorter access time (MD: −1.03; 95 % CI: from −1.57 to −0.49; p = 0.0002) and X-ray exposure time (MD: −42.71; 95 % CI: from −45.05 to −40.37; p < 0.00001) than gradual dilation. Our results show that One-shot dilation is an effective and safe procedure for tract creation in PCNL, with shorter access time and X-ray exposure time and without increased complications. As only four studies with small study populations were available, more high-quality larger trials with longer follow-up are recommended. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PNL) is the procedure of choice for large renal stones. Since its introduction in 1976, many aspects of the operative technique and the endoscopic equipments have had constant evolution, increasing the success rates of the procedure. We performed a literature search using Entrez Pubmed from January 2000 to July 2007 concerning PNL and many aspects related to all steps of the procedure. We could verify that PNL in supine position has been proved as an acceptable option, but more worldwide experience is necessary. Urologists must be trained to gain their own renal tract access. Minipercutaneous PNL still needs equipments improvements for better results. Tubeless PNL is increasing in popularity and different tract sealants have been studied. Medical prevention is proved to be effective against stone recurrence and should be always used after PNL. Although the evolution of the technique in the last 20 years, urologists must continue to improve their skills and develop new technologies to offer to the patients more and more a safe and effective option to treat large renal stones. [ABSTRACT FROM AUTHOR]