Clinical comparison of the efficiency and security of balloon dilators versus fascial dilators in percutaneous nephrolithotripsy (PCNL)

Abstract

Objective:To compare the efficiency and security of the balloon dilators versus fascial dilators in percutaneous nephrolithotripsy (PCNL), We compared the difference of intraoperative and postoperative parameters of patients using these two different methods of expansion and having no significant statistic differences in peroperative parameters.Methods:This is a retrospective analysis of 134 patients undergoing PCNL with upper urinary calculi from January 2012 to January 2014 in Luoyang Central Hospital affiliated to Zhengzhou University. These patients meeting the inclusion criteria were divided into two groups: the group of balloon dilators (group A) and the group of fascial dilators (group B). Two groups were compared for success rate of first expansion, clearance of stone, duration of surgery, intraoperative hemorrhage, blood transfusion rate, postoperative hospitalization and the incidence of complications.Result:In Group A, a total of 91 patients (51 men and 40 women, mean age 51.22±8.96 years, ranged from 28 to 68 years, the calculi maximum diameter from 0.9 to 4.5cm, 28 cases with a history of gravel, mean Body mass index 24.20±2.34, 73 cases with hydronephrosis and 26 cases with underlying diseases such as hypertension, diabetes and the like) undergoing PCNL were retrospectively reviewed. Similarly, In Group B, a total of 43 patients (28 men and 15 women, mean age 49.64±10.62 years, ranged from 15 to 70 years, the calculi maximum diameter from 1.1 to 5.2cm, 18 cases with a history of gravel, mean Body mass index 24.40±2.70, 38 cases with hydronephrosis and 14 cases with underlying diseases such as hypertension, diabetes and the like) undergoing PCNL were retrospectively reviewed. Our results showed that there was a statistically significant better outcome in Group A than in Group B in terms of success rate of first exploration, duration of operation, intraoperative hemorrhage, postoperative hospitalization and the incidence of complications. Additionally, there was no statistically significant difference with respect to clearance of stone and incidence of blood transfusion in the two groups.Conclusion:Balloon dilators had shorter operation time, less bleeding, higher success rate of first expansion, less postoperative complications and shorter postoperative hospitalization than fascial dilators in PCNL.

Percutaneous nephrolithotomy assisted by LithoClast master in one-phase treatment for staghorn renal stones with refractory infections

“…The traditional method of channel dilatation involves the application of fascial dilators, metal dilators and balloon dilators [10,[15][16][17]. Among them, balloon dilators are characterized by non-compliance and can be a transverse and homogeneous dilation [18]. This expansion can produce a kind of radial blunt lateral pressure, which evenly changes the diameter and shape of the balloon, thereby reducing the possibility of tearing and bleeding of tiny blood vessels in the kidney [18,19].…”

“…Among them, balloon dilators are characterized by non-compliance and can be a transverse and homogeneous dilation [18]. This expansion can produce a kind of radial blunt lateral pressure, which evenly changes the diameter and shape of the balloon, thereby reducing the possibility of tearing and bleeding of tiny blood vessels in the kidney [18,19]. Balloon dilators can expand to F24 at a single time and effectively expand the whole channel, rather than expanding a point or a segment of the channel.…”

“…Balloon dilators can expand to F24 at a single time and effectively expand the whole channel, rather than expanding a point or a segment of the channel. The force generated between the balloon dilators and the tissue surrounding the channel will not cause the dilators to move easily, avoiding the risk of channel loss, too long channel or too short channel, and thus greatly shortening the operation time [18]. Moreover, balloon dilators can reduce the risk of collecting system perforation.…”

Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years’ experience

“…It is a minimally invasive procedure providing high success rates with an excellent safety profile. [2][3][4][5][6] Intraoperative detection of residual fragments during PCNL may be challenging. Presence of residual fragments may need for auxiliary procedures like ESWL, flexible URS or redo PCNL.…”

“…Presence of residual fragments may need for auxiliary procedures like ESWL, flexible URS or redo PCNL. [5][6][7][8][9] Flexible nephroscopy is another modality being used in different centers to improve the outcomes of PCNL. However, there is a wide variability in literature regarding the efficacy of intraoperative flexible nephroscopy in PCNL.…”