A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy

Srivastava, Alok; Singh, Sanjeet Kumar; Dhayal, Ishwar Ram; Rai, Priyanka

doi:10.1007/s00345-016-1929-9

Cited by 40 publications

(68 citation statements)

References 14 publications

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“…OSD was determined to significantly decrease the transfusion rate, hemorrhage rate and the extent of hemoglobin decrease compared with those of MTD. These results support the results of previous studies (6,(8)(9)(10)(11)(12)(13)(14)(18)(19)(20). In addition, no statistically significant differences were observed between the two groups regarding the stone-free rate.…”

Section: Discussionsupporting

confidence: 91%

“…Tract creation and dilation are fundamental steps in percutaneous renal surgery and are required for three traditional types of dilation, including MTD, AD and BD (21)(22)(23). OSD was first introduced by Frattini et al (6); several studies have investigated the safety and effectiveness of OSD compared with those of other methods (7)(8)(9)(10)(11)(12)(13). Numerous RCTs on these methods have been reported and a previous meta-analysis has been published by Cao et al (15).…”

Section: Discussionmentioning

confidence: 99%

“…AD and MTD are inexpensive, but longer durations of application and X-ray exposure are required. The OSD technique, which was first proposed by Frattini et al (6), may achieve the same effects compared with the other three dilation methods (7)(8)(9)(10)(11)(12)(13); however, OSD may cause parenchymal damage (14). A previous meta-analysis compared the four dilation methods (15), but only four randomized clinical trials (RCTs) were included and three combinations of tract dilation methods were analyzed.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta‑analysis

Xiao

et al. 2020

Exp Ther Med

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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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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta‑analysis

Xiao

et al. 2020

Exp Ther Med

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“…To conclude for the dilatation techniques, comparative studies showed that none of the aforementioned dilatation methods were significantly better than another, and the choice depends on the clinical situation, stone condition and surgeon's preference …”

Section: Pcnlmentioning

confidence: 99%

“…63,64 To conclude for the dilatation techniques, comparative studies showed that none of the aforementioned dilatation methods were significantly better than another, and the choice depends on the clinical situation, stone condition and surgeon's preference. 65,66 Size of tract Currently, there are at least two nomenclature for PCNL tract size, which might lead to confusion (Table 2). 67,68 Although the stone clearance rate is good with the standard PCNL, mini-PCNL has been shown to have less blood loss, reduced hospital stay and more tubeless procedures without compromising the stone clearance rate or increasing the infective complications.…”

Section: Dilatation Of Tractmentioning

confidence: 99%

Updates in endourological management of urolithiasis

Teoh

2018

Int J of Urology

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Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy‐assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

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Super‐stiff guidewire or loach guidewire during percutaneous nephrolithotomy?

et al. 2023

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ObjectivesThe objectives of this work are to compare the outcomes between loach guidewire and super‐stiff guidewire during percutaneous nephrolithotomy (PCNL) and find potential indications of different guidewires.Patients and methodsWe retrospectively reviewed our institutional PCNL database from 2017 to 2021. Patients who underwent PCNL guided by loach guidewire were assigned to group A (489 patients); patients who received super‐stiff guidewire were assigned to group B (269 patients). Preoperative demographic data, intraoperative parameters, and postoperative complications were compared. The conditions and reasons of failed placement of guidewire needed readjustment were evaluated as well.ResultsPreoperative demographic data and most intraoperative parameters were not statistically different between the groups. Postoperative Clavien–Dindo complications were also comparable, with low rate of complications. However, failed placement of guidewire more occurred in group A (8.2% vs. 4.0%, respectively, p = 0.03). Compared with the super‐stiff guidewire, the loach guidewire was easier pass/slip into any place either it be perinephric or blood vessels. In most failed group A cases and all failed group B cases, the guidewire was placed in the perirenal fat. Six patients (15%) in group A, the guidewires entered into vessels.ConclusionsOur results support that the faulty placement of loach guidewire is significantly more common compared with super‐stiff guidewire. Double confirmation is needed to prevent a major complication out of wrong dilatation whenever there is doubt about the wrong location of the guidewire.

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A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy

Cited by 40 publications

References 14 publications

Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta‑analysis

Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta‑analysis

Updates in endourological management of urolithiasis

Super‐stiff guidewire or loach guidewire during percutaneous nephrolithotomy?

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