Failed percutaneous balloon dilation for renal access: Incidence and risk factors

Joel, Andrew B.; Rubenstein, Jonathan N.; Hsieh, Michael H.; Chi, Tom; Meng, Maxwell V.; Stoller, Marshall L.

doi:10.1016/j.urology.2005.02.018

Cited by 40 publications

(20 citation statements)

References 11 publications

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“…For these reasons, we used Amplatz dilatation in the patient in whom balloon dilatation had failed, and the Amplatz procedure was successful. In some previous studies, the failure of balloon dilatation has been attributed to perinephritic scar tissue, 13 but the failure of Amplatz dilatation caused by kidney hypermobility has been reported in only one previous study. However, the dilatation method (the "one-shot" technique) used in that research was different from conventional Amplatz dilatation.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Balloon Dilatation versus Amplatz Dilatation for Nephrostomy Tract Dilatation

Gönen

Istanbulluoglu

Cicek

et al. 2008

Journal of Endourology

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Section: Discussionmentioning

confidence: 97%

“…Previous studies also confirm our findings and because of this, we feel that reusing balloon dilators is impractical as a routine practice. 13 However, reusing an Amplatz dilator is more practical than reusing a balloon dilator. During the reuse of Amplatz dilators, we did not note any extra difficulties or complications.…”

Section: Discussionmentioning

confidence: 99%

Balloon Dilatation versus Amplatz Dilatation for Nephrostomy Tract Dilatation

Gönen

Istanbulluoglu

Cicek

et al. 2008

Journal of Endourology

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“…58 Balloon dilatation has the advantage of less radiation exposure, but has a lower success rate, especially in patients with calyceal stones or staghorn stones 59 and previous renal surgery. 60 Because of the tapered end of the balloon, the tract created by the balloon might not provide complete access to the collecting system. 61 In an effort to reduce the radiation exposure, one-step dilatation using a semirigid dilator was introduced.…”

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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“…We do believe, however, that rigid dilation should still remain in the repertoire for percutaneous surgeons in the rare instance that balloon dilation proves inffective. 7 While using retrograde instrumentation to clear a path for percutaneous access and to maximize clearance of other calices has merit, we believe that with proper percutaneous access, endoscopic guidance adds little while adding cost and operative time. At the University of Wisconsin, we use upper-pole access whenever possible, because it provides excellent access to most calices and allows for clearance of even complex staghorn calculi.…”

mentioning

confidence: 99%

Rebuttal

Benway¹,

Nakada

2008

Journal of Endourology

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T HE ASSERTIONS of Drs. Kumar and Keeley, while compelling, do not provide convincing evidence that Amplatz dilation is superior to balloon dilation. Multiple studies have reproducibly demonstrated a lower rate of hemorrhagic complications in patients undergoing balloon dilation compared with serial dilation. 1-5 The single report in the literature that casts favorable light on Alken dilators was performed by experienced percutaneous surgeons. 6 Certainly, the reusability of Alken dilators does diminish intraoperative costs over balloon dilation, but one must also consider the costs of complications. When one considers the costs associated with prolonged hospitalization, blood transfusion, and potential angiographic studies and therapy, the cost savings become less relevant, particularly in less experienced hands.Furthermore, with regard to success as an initial modality of tract dilation, Joel and associates 7 corroborated that balloon dilation has a 92% success rate in initial procedures, which, combined with its greater safety profile, renders balloon dilation a preferable means of initial access. We do believe, however, that rigid dilation should still remain in the repertoire for percutaneous surgeons in the rare instance that balloon dilation proves inffective. 7 While using retrograde instrumentation to clear a path for percutaneous access and to maximize clearance of other calices has merit, we believe that with proper percutaneous access, endoscopic guidance adds little while adding cost and operative time. At the University of Wisconsin, we use upper-pole access whenever possible, because it provides excellent access to most calices and allows for clearance of even complex staghorn calculi. Moreover, the upper-pole access path usually minimizes curvature of the tract, thus addressing the concerns over shearing forces raised by Drs. Kumar and Keeley. 8 In summary, we support that while rigid dilation retains a secondary role in percutaneous access, balloon dilation remains the primary means of tract dilation for most urologists today. Furthermore, with proper caliceal access, most large renal stones are safely and effectively managed with percutaneous surgery alone, without the need for concurrent retrograde instrumentation. References1. Turna B, Nazli O, Demiryoguran S, Mammadov R, Cal C. Percutaneous nephrolithotomy: Variables that influence hemorrhage. Urology 2007:69:603-607. 2. Şafak M, Gögüs C, Soygür T. Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: Experience with 95 cases and comparison with the fascial dilator system. Urol Int 2003;71:382-384. 3. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on the incidence of renal hemorrhage. J Urol 1997;157:1229-1231. 4. Heggagi MA, Karsza A, Szüle E Jr. Use of different types of dilator systems in the prevention of complications of percutaneous (PC) renal surgery. Acta Chir Hung 1991;32:365-369. 5. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during nephrol...

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Failed percutaneous balloon dilation for renal access: Incidence and risk factors

Cited by 40 publications

References 11 publications

Balloon Dilatation versus Amplatz Dilatation for Nephrostomy Tract Dilatation

Balloon Dilatation versus Amplatz Dilatation for Nephrostomy Tract Dilatation

Updates in endourological management of urolithiasis

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