Nephrostomy Tract Dilation Using a Balloon Dilator in Percutaneous Renal Surgery: Experience with 95 Cases and Comparison with the Fascial Dilator System

Abstract

Introduction: Nephrostomy tract dilation is one of the important steps of percutaneous renal surgery. In this study, we present our initial experience with the balloon dilator in 95 patients and compare our results retrospectively with a group of 30 patients in whom Amplatz dilators were used. Patients and Methods: The medical records of 95 patients who underwent percutaneous renal operations, including percutaneous nephrolithotomy and antegrade endopyelotomy, between September 1999 and September 2002 were reviewed. All procedures were performed using balloon dilators. The operative technique is the same as the other dilation procedures. Thirty consecutive patients who had previously undergone percutaneous renal surgery using the Amplatz dilators were taken as the control group and their charts were reviewed retrospectively, and the results compared with the results of patients in whom balloon dilation was used. Results: There were no major perioperative complications or deaths in both groups. The mean operative time and tract formation times for the balloon dilation group and the Amplatz dilation group were 106.8 ± 41.4 and 11.2 ± 3.0, and 116.4 ± 23.7 and 16.3 ± 2.4 min, respectively. Thirteen (13.7%) patients had significant bleeding and required blood transfusion in the balloon dilation group, whereas 5 (16.6%) patients had significant bleeding in the Amplatz dilation group. Collecting system perforation due to too far advancement of the dilator occurred in 11 (11.6%) patients but there was no major parenchymal or vascular injury medially in the balloon dilation group. On the other hand, collecting system perforation occurred during sequential Amplatz dilation in 5 (16.6%) patients. Conclusion: We believe that the balloon system allows one-step dilation and shortens the dilation procedure. It may minimize bleeding which can occur during the stepwise fascial dilation. When using fascial dilators it is sometimes possible to go out of the collecting system by changing the size of the dilators. We think that balloon dilation may prevent these intraoperative and time-consuming situations.

Parenchymal Thickness: Does It Have an Impact on Outcomes of Percutaneous Nephrolithotomy?

“…The effect of dilation technique on hemorrhagic complications is regarded as confusion that different results are reported in the literature. Although some authors [32,33,34,35] reported that the telescopic, balloon, and one-shot dilation had similar hematologic safety profiles, others [36,37] reported lower transfusion rates for balloon dilation. In the present study, the patients were stratified according to the dilation technique.…”

Contemporary Practice of Percutaneous Nephrolithotomy: Review of Practice in a Single Region of the UK

“…This would appear contrary to recent papers suggesting a lower transfusion rate with pneumatic dilation compared to multi-incremental techniques. 19,20 However, we have only reported a small number of cases and the dilation technique was on the whole poorly recorded.…”

A comparison of balloon and amplatz dilators in percutaneous nephrolithotomy: a retrospective evaluation

“…From the first application of nephrostomy in 1955, developments in its technique, and equipment have improved patient outcomes. [12][13][14] Kukreja et al [15] demonstrated that during intrarenal access, the selection of the appropriate calyx had not any impact on the development of complications, on the contrary following optimal access with a needle the dilatation technique used had effected rates of bleeding. In 1994, Stoller et al [16] investigated the effects of telescopic metal, and balloon dilatation on blood loss, and couldn't find any significant difference between both methods.…”