Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial

Abstract

Purpose To compare balloon with Amplatz for tract dilation in totally ultrasonographically guided PCNL (UPCN). Methods We randomized 66 patients candidate for sonographically guided PCNL in the flank position in two study groups. In the first group, we used single step Amplatz dilation (AG) technique in which the 28- or 30-French Amplatz dilator is used for tract dilation. In the other group, we dilated the tract using balloon dilator (BG). We compared procedure time, success rate of dilation, and postoperative clinical outcomes and cost between two groups. ResultsThe rate of short dilation was higher in the Amplatz group (57.6%) compared with Balloon group (36.4%) (P=0.08). When using Amplatz for lower pole access, short dilation occurred in 81% of cases compared with 44% in the BG (P=0.02). Overall operation was longer in the AG (80±21 versus 65±20 minutes P=0.02). Stone free rate was 87.9% in the AG compared with 72.7% in the BG (p=0.12). Mean cost of the surgery was 603±85 USD and 718±78 USD in the AG and BG, respectively (P=0.0001). Hemoglobin drop, transfusion rate, renal function alteration, duration of hospitalization, and complication rate based on Clavien classification were similar in both groups. Conclusions AG showed a higher rate of short dilation compared with BG; consequently, overall operating time was significantly longer in the AG whereas BG was significantly more expensive than AG. Bleeding and other complications were similar in two groups. We observed an advantage for balloon dilation over Amplatz when approaching the lower pole calyxes.

The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous Nephrolithotomy

“…This result was quite different from the previous studies [24,25], we do not suggest BD in cases without hydronephrosis for beginners; for such cases, two-step TMD under ultrasound as we previously reported or xray guidance may be a better choice. The cost of the disposable balloon is much higher than that of the TMD in China due to insurance policy; the telescopic metal dilator can be reused, which further lowers the cost of the operation.…”

“…Moreover, the end of the balloon dilator is taper-shaped and has an approximate tip length of 0.5 cm beyond the taper; so the measured balloon length should exclude the length of the tip to avoid short dilation in patients without hydronephrosis. Pakmanesh H [25] performed a prospective study to check the feasibility of performing USG Guided Balloon dilatation (24 FR) of PCNL tract for access, and they concluded that a higher rate of short dilation occurred in Amplatz dilation compared that with balloon dilation, which were quite different from present study. A poorly dilated calyx was not good for performing ultrasoundguided tract dilation using a balloon dilator.…”

Percutaneous nephrolithotomy tract dilatation techniques comparison (Balloon vs. Amplatz): Our Experience in Middle East.

“…On the opposite aspect, Hamid Pakmanesh et al observed that bleeding and different headaches had been comparable inside the balloon and amplatz teams, whereas operative time become longer within the amplatz organization with a higher charge of short dilation. Concerning the approaching the decrease organization calyces, the balloon technique become superior 16 .…”

Comparison of balloon dilation tract real-time monitored by ultrasound combined with endoscopic versus unitary ultrasound guided in percutaneous nephrolithotomy: a retrospective study

“…At present, the way of tract establishment is Amplatz dilation or balloon dilation. Pakmanesh et al studies have pointed out that although the cost of balloon dilator is higher, it is better than Amplatz dilation in safety and success rate [4]. Recent studies have pointed out that the whole process of establishing the tract with balloon dilator can be monitored by ultrasound, but for patients without hydronephrosis or obesity, there may still be not reached the desired calyx (short dilation) or tract displacement without uoroscopy assistance, resulting in tract establishment failure or bleeding [5].…”