Comparison of single-step renal dilatation and serial renal dilatation in percutaneous nephrolithotomy

Abstract

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.

Risk Factors for Intra-operative Bleeding in Percutaneous Nephrolithotomy in an Academic Center: A Retrospective Study

“…Percutaneous nephrolithotomy (PNL) is an effective, safe, and minimally invasive treatment method with low complications for renal and ureteral calculi refractory to extracorporeal shock wave lithotripsy therapy (ESWL) and in patients with anatomic variations (1)(2)(3)(4). In fact, this method has been known as the gold standard of care for treating renal stone diseases (5). Despite the success rate of over 90%, there are inherent complications such as adjacent organs, sepsis, fistulas, stenosis of excretory way, fluid overload, serum electrolytes imbalance, hypothermia, irreversible renal lesion, and even death (6,7).…”