The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous Nephrolithotomy

Abstract

Background: To evaluate the feasibility and safety of balloon dilation (BD) in totally ultrasound-guided percutaneous nephrolithotomy (PCNL). Methods: The data of 95 patients underwent BD were collected in this retrospective study between August 2016 and December 2018. During the same period, telescopic metal dilation was used in 1161 patients. Ninety five patients were selected as the control group and matched at a 1:1 ratio to index balloon dilation (BD) cases in regards to Guy's stone score, age, sex, BMI, degree of hydronephrosis and stone area. Peri-operative data were compared between the two groups. Results: Total operative time was significantly shorter in the BD group (62.2 ± 22.4 min vs. 70.2 ± 25.8 min, p = 0.024). Tract establishment time was significantly shorter in the BD group (3.4 ± 1.8 min vs. 4.3 ± 2.3 min, p < 0.001). The success rate of tract dilation by first attempt was higher in the TMD group compared with that of BD group; however the difference was not statistically significant. There was no significant difference between groups with regards to complication and stone-free rates. The cost of PCNL in the BD group was significantly higher than that of the TMD group (US $4831.4 ± 1114.8 vs. US $4328.4 ± 975.7, p = 0.012). Subsequent analysis revealed that mild or no hydronephrosis were risk factor for failure of balloon dilation under ultrasound. Conclusions: BD has acceptable complication and stone free rates compared with those in TMD; however, BD under ultrasound is not suggested for stone cases without hydronephrosis.

A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy

“…This was supported by those studies of mini-PCNL (13,14), in which the failure rate of serial dilation up to 18 Fr was generally less than 5%. On the contrary, the tips of large-sized Amplatz dilators are relatively blunt and tend to push the kidney away before they enter the collecting system, which causes a status of short dilation (15,16). Second, all the small-sized (8-Fr to 16-Fr) Amplatz dilators were advanced at a fixed depth as measured earlier.…”

“…In another study with 207 cases undergoing ultrasoundguided balloon dilation, the success rate of tract dilation on the first attempt was 88.4% (11). Short dilation was considered to be the main cause of failure with balloon dilation (15,16). Obesity was reported to predict failure of ultrasound-guided balloon dilation, as it was reported that the success rate was 76.9% in normal weight and 79.0% in overweight, but it was only 45.7% in obese subjects (6).…”

“…In another study, the presence of staghorn stones, previous ipsilateral open nephrolithotomy, and low pole access independently predicted a failure of tract establishment with balloon, while the presence of hydronephrosis of the target calyx increased the likelihood of success (11). In general, to monitor these dilators under ultrasound is an advanced technique and is limited to experts and is specially technically challenging in cases without hydronephrosis (16). Different from the above techniques by using ultrasound to monitor the process of dilation, our method was characterized by checking the initial small-sized dilation with a ureteroscope.…”

“…From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator.…”

Comparison of balloon dilation tract real-time monitored by ultrasound combined with endoscopic versus unitary ultrasound guided in percutaneous nephrolithotomy: a retrospective study

“…The continuous compression of injured vessels in the tract during balloon dilatation resulted in less blood loss [9]. Although balloon dilatation has many advantages in establishing tract, there are still some problems such as too shallow dilation (short dilation), too deep dilation and tract displacement in the process of dilatation, resulting in serious complications such as tract establishment failure, bleeding and renal parenchyma injury, especially in the patients without hydronephrosis [10,11] and obesity [12]. The correct puncture path and reasonable expansion method are effective methods to reduce the amount of blood loss [13].…”