Percutaneous Nephrolithotomy with Amplatz and Alken Dilators: An Eight-Year Single Tertiary Care Centre Experience

Abstract

BackgroundPercutaneous nephrolithotomy (PNL) is the standard procedure for patients with renal stones over 2 cm in diameter. We analyzed complications after this procedure focusing on two different methods of tract dilation.Material/MethodsBetween August 2008 and April 2016 222 percutaneous nephrolithotomies were performed in a total of 208 patients. The Group I (n=123) comprised patients where Alken dilatators were used, while Group II (n=99) comprised patients where Amplatz dilators were used. Efficacy was examined based on ultrasound and x-ray examination one month after the procedure. Complications were recorded using Clavien Dindo classification.ResultsEfficacy was 85.3% and 86.8% in group I and II, respectively (p=0.77). Grade I complications were present in 14.6% and 3%, grade II were present in 9.7% and 8%, grade IIIa were present in 2.4% and 2%, grade IIIb were present in 1.6% and 2%, grade IVa were present in 1.6% and 7%, grade IVb were present in 3.2% and 1% in Group I and Group II, respectively. These differences were statistically significant (p=0.03).ConclusionsEfficacy was comparable between Alken dilator and Amplatz dilator groups. In group I, there were more postoperative fevers >38.5 °C and a higher rate of urosepsis. On the other hand, in group II we observed more pleural injuries. All differences resulted from the type of access to the kidney (inter/infracostal), punctured calyx, and utilization (or not) of access sheath rather than type of dilators itself.

Retrograde intrarenal surgery for management of kidney stones smaller than 20 mm: A singe center experience of 452 cases

“…Patients' demographic data are summarized in Table 1.The mean stone size was 13.5 mm (range 7-20 mm). The mean stone sizes were 13.6 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 33.8%), and multiple calyces (n=88; 19.4%). Patients' stone characteristics are summarized in Table 2.…”

“…Considering complication rates, RIRS may have a lower risk of severe complications compared to PCNL because the instruments used are of lower caliber and flexible, and operation is performed through direct vision. Bryniarski et al [18] have assessed outcomes after RIRS and PCNL. They have found that transfusion required in 13 of the PCNL patient group and no transfusion in the RIRS patients group [18] .…”

Updates in endourological management of urolithiasis

“…57 However, Alken dilators were shown to have higher infective complications due to the fact that an access sheath was not used during the study, and Amplatz dilators were associated with higher pleural injuries, as they were used more for intercostal puncture. 57 Both had similar stone-free rates and complication rates, with Alken dilators being more cost-effective. 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.…”

“…Both are equally safe and do not differ in terms of hemoglobin drop and blood transfusion . However, Alken dilators were shown to have higher infective complications due to the fact that an access sheath was not used during the study, and Amplatz dilators were associated with higher pleural injuries, as they were used more for intercostal puncture . Both had similar stone‐free rates and complication rates, with Alken dilators being more cost‐effective …”

“…There are two types of serial dilatation: (i) the telescopic metal dilatation (Alken dilators); and (ii) the semi‐rigid fascial dilatation (Amplatz dilators). Both are equally safe and do not differ in terms of hemoglobin drop and blood transfusion . However, Alken dilators were shown to have higher infective complications due to the fact that an access sheath was not used during the study, and Amplatz dilators were associated with higher pleural injuries, as they were used more for intercostal puncture .…”