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

Abstract

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.

Perkütan Nefrolitotomide Renal Dilatasyon Yöntemlerinin Sonuç ve Komplikasyonlar Üzerine Etkisi

“…Perkütan giriş yolu oluşturulurken balon dilatatörler, amplatz seri dilatatörler ve metal teloskopik dilatatörler kullanılabilmektedir. Balon dilatatörler, en modern yöntem olmakla birlikte daha yüksek maliyet problemini de getirmektedir (18). Alternatif olarak amplatz ve alken tip dilatatörlerdeki ardışık uygulamaları ortadan kaldırmak üzere one-shot dilatasyon yöntemi tanımlanmış, güvenli ve etkin bir yöntem olarak floroskopi süresi ve kanama miktarını azalttığı, balon dilatatörlere göre maliyet avantajı sağladığı gösterilmiştir (19,20).…”

“…Teorik olarak, balon dilatasyon sırasında küçük damarlara uygulanan kompresyonun, kanamayı azaltan bir faktör olabileceği düşünülmektedir (21). Literatürde balon dilatatörlerin, amplatz ve metal teloskopik dilatatörlere göre daha az postoperatif hemoglobin düşüşü sağladığını gösteren yayınlar mevcuttur (18). CROES çalışmasında ise aksine balon dilatasyonun seri dilatasyona göre daha fazla kanama ve transfüzyon ile ilişkili olduğu bulunmuştur (9).…”

A novel approach in creating nephrostomy using a double-lumen access sheath during endoscopic combined intrarenal surgery

“…Compared to the conventional dilation method using the dilation kit or balloon dilator, one-shot dilation is more likely to decrease the fluoroscopy time and bleeding amount and is currently becoming a common technique in creating percutaneous tracts. However, this technique might be associated with renal parenchymal damage, microvasculature damage, and a lower successful dilation rate due to a lack of surgical experience (13)(14)(15). Given that approximately 60 cases are needed as a learning curve for competence in percutaneous renal access (23,24), the selection of one-shot dilation by less-experienced surgeons remains debatable.…”

“…Procedures that could cause complications when creating a tract include inserting the main tract after guidewire placement and placing a safety (second) guidewire. The current one-shot dilation method has been reported to be convenient and safe but requires experience (13)(14)(15). Furthermore, insertion of the safety guidewire requires removal and re-insertion of the tract, increasing the risk of complications, particularly when lessexperienced doctors perform the procedure.…”

One-shot dilation versus metallic dilation technique for access in percutaneous nephrolithotomy: comparison of efficacy, access time and fluoroscopic time

“…The disadvantages of these methods are that they are more time-consuming and involve longer exposure time to x-ray. 3,4 Balloon dilation is the most accepted option and perceived as being the safest method but its high cost limits its routine use. 5,6 The recognized link between exposure to x-rays and some risk of cancer necessitates limitation of exposure during the procedures.…”