Single-step dilatation in percutaneous nephrolithotomy, its safety and efficacy: A prospective, single-center study

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is gold standard technique for the treatment of renal calculi larger than 2 cm or complex renal calculi. Establishment of nephrostomy tract is the important step during PCNL. Hence, this study was conducted to evaluate the effectiveness of single-step dilatation in patients with renal calculi undergoing PCNL. Methods: This is a prospective, single-center study conducted between August 2014 and December 2017. Patient who underwent PCNL using single-step dilatation between the study period were included in the study. Demographic details, stone characteristics, operative time dilatation time, radiation exposure time, rate of complication and blood transfusion were recorded. Data was analyzed and reported using summary statistics. Results: A total of 332 patients were enrolled in this study. The mean (SD) age was 42.46 (15.53) years and 181 (54.52%) patients were male. Overall, stone clearance rate was 92%. The mean (SD) operative time was 62.74 (29.61) minutes, tract dilatation time was 2.18 (1.05) minutes, and the radiation exposure time was 12.68 (6.45) seconds. Blood transfusion was required in 12(3.6%) patients. No major complications were reported during post-operative period. Conclusion: Single-step dilatation technique is safe, economical and feasible technique with added advantage of lesser time of dilatation, lesser radiation exposure and lesser chance of blood transfusion.

Two Different Renal Dilatation Techniques in Percutaneous Nephrolithotomy: One-Shot Dilation vs. Sequential Dilation

“…In an analysis of the international prospective database of more than 5.800 cases, de la Rosette et al reported low-grade complications (grade 1 and grade 2) in 16.4% of cases, grade 3a and 3b complications in 3.6% of cases, and severe complications in 0.5% of the cases, while there were no complications in 79.5% of the cases. [18] Girisha et al [8] reported a 20% complication rate in 332 patients who underwent OD-alone, and there were no major complications. Injury to the kidney collecting system was reported in 5.2% of the cases, while urinoma formation was determined in only 0.2% of the cases.…”

“…In the literature, it has been reported that the one-shot kidney dilatation technique is a safe method that has lower radiation exposure with less cost. [7,8] The goal of one-shot dilatation is to provide percutaneous canal formation in a single step without the need for serial dilatations.…”

Efficacy and safety of modified tract dilation technique using simultaneous pulling of proximal and distal ends of a guidewire for percutaneous nephrolithotomy in modified supine position

“…It can fix the kidney during the tract dilation maneuver and also help introduce instruments for tract dilation, such as the fasciacutting needle and nephrostomy balloon catheter. Moreover, it was reported that technique of one shot renal dilation using nephrostomy balloon were safer and more effective than metal telescopic dilation or serial Amplatz dilation for nephrostomy tract dilation, resulting in a shorter tract dilatation fluoroscopy time and less hemoglobin drop [ 28 29 30 ]. Therefore, the nephrostomy tract can be made faster, safer, and more easily than the conventional method.…”

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

“…After its first description in 1976 by Fernström and Johansson, percutaneous nephrolithotomy (PCNL) has now become the standard of care for the management of renal stone disease. [ 1 2 ] It is a minimally invasive technique associated with higher success rate and lower complications for the efficient management of renal calculi >2 cm in diameter, staghorn calculi, and larger lower calyceal calculi. [ 3 4 ]…”

“…Gaining access to the pelvi-calyceal system by renal puncture and subsequent dilatation of the tract is a crucial and challenging step in this procedure and is conventionally done by one of the following three techniques – serial Alken metal telescope dilators, semi-rigid Amplatz sequential fascial dilators, and single-step balloon dilator. [ 1 5 ] The reusable metal telescopic dilators are economical, and there is less blood loss because of the tamponade effect on renal parenchyma by metal dilators. Sequential fascial dilators are disposable, and there is possibility of more blood loss as the tamponade effect is lost during sequential exchange of these fascial dilators.…”