Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

Nalbant, İsmail; Karakoyunlu, Nihat; Yeşil, Süleyman; Ekıcı, Musa; Zengın, Kürşad; Öztürk, Ufuk; İmamoğlu, Abdurrahim

doi:10.1089/lap.2015.0618

Cited by 8 publications

(18 citation statements)

References 19 publications

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“…According to our eligibility criteria, one RCT and five CCTs were included in this systematic review and meta-analysis. [16][17][18][19][20][21] Basic study design characteristics and quality assessments of the included studies are provided in table 1. In each of the included studies, groups were relatively homogeneous in terms of stone location, size and shape.…”

Section: Literature Searchmentioning

confidence: 99%

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Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis

et al. 2020

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ObjectiveTo compare the safety and efficacy of balloon and Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy (PCNL).MethodEMBASE, PUBMED, MEDLINE and the Cochrane Central Register of Controlled Trials were searched for pertinent studies up until 30 October 2019. Pooled effects were calculated as ORs with 95% CIs or mean differences (MD) with 95% CIs. Endpoints included postoperative decrease in haemoglobin, transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, access time, total operation time and length of postoperative hospitalisation (LPH). Bonferroni’s correction was intercalated to reduce the likelihood of making a meta-analytical false positive.ResultsOne randomised controlled trial and five controlled clinical trials were included, which involved 1317 patients in total. We found a lower drop in postoperative haemoglobin for patients receiving balloon dilation compared with those in the Amplatz group (MD=−0.21, 95% CI −0.33 to 0.09, p=0.0005; Bonferroni correction a=0.005). Access time in the balloon group was also, on average, 2.61 min shorter than the Amplatz group (MD=−2.61, 95% CI −4.20 to 1.01, p=0.001; Bonferroni correction a=0.005). No significant differences were identified between the two dilation methods in terms of transfusion rate, complication rate, successful dilation rate, stone-free rate, fluoroscopy time, total operation time and LPH.ConclusionBalloon dilation is a safe and effective tract dilation technique for access creation during fluoroscopically guided PCNL. Both of methods have similar success rates although balloon dilation is associated with significantly less postoperative haemoglobin decline and shorter access time. Therefore, balloon dilation appears to be the superior tract dilation technique, but further confirmatory research is required to confirm these findings.

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Section: Literature Searchmentioning

confidence: 99%

“…All studies reported transfusion rates [16][17][18][19][20][21] but only one reported that balloon dilation can significantly reduce the need for blood transfusion. 21 The remaining five studies did not verify this finding and therefore could not reach the same conclusion.…”

Section: Literature Searchmentioning

confidence: 99%

Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis

et al. 2020

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“…To conclude for the dilatation techniques, comparative studies showed that none of the aforementioned dilatation methods were significantly better than another, and the choice depends on the clinical situation, stone condition and surgeon's preference …”

Section: Pcnlmentioning

confidence: 99%

“…63,64 To conclude for the dilatation techniques, comparative studies showed that none of the aforementioned dilatation methods were significantly better than another, and the choice depends on the clinical situation, stone condition and surgeon's preference. 65,66 Size of tract Currently, there are at least two nomenclature for PCNL tract size, which might lead to confusion (Table 2). 67,68 Although the stone clearance rate is good with the standard PCNL, mini-PCNL has been shown to have less blood loss, reduced hospital stay and more tubeless procedures without compromising the stone clearance rate or increasing the infective complications.…”

Section: Dilatation Of Tractmentioning

confidence: 99%

Updates in endourological management of urolithiasis

Teoh

2018

Int J of Urology

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Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy‐assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.

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“…Biz çalışmamızda; operasyon süresinin uzamasının, çocuklarda PNL ameliyatı yapılırken göz önünde bulundurulması gereken artmış kan kaybı için bağımsız bir risk faktörü olduğunu saptadık. Bu verilerin doğruluğunun teyit edilmesi amaçlı daha çok sayıda hasta verileri ile prospektif çalışmaların yapılması gerektiğini düşünmekteyiz.olduğuna dair hiçbir kanıt bulamadıklarını ifade etmişlerdir(28). Bizim çalışmamızda da single step (tek aşamalı) dilatasyon ve Amplatz aşamalı dilatasyon metodları arasında kan kaybı riski üzerinde anlamlı farklılık saptanmamıştır.…”

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Investigation of Factors Affecting Bleeding in Children with Percutaneous Nephrolithotomy

Uçar¹,

Kısa²,

Yücel³

et al. 2019

Akd Med J

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Investigation of Factors Affecting Bleeding in Children with Percutaneous Nephrolithotomy ÖZ Amaç: Erişkin hastalarda olduğu gibi çocuk hastaların böbrek taşı tedavisinde de etkili ve güvenle kullanılan perkütan nefrolitotomi (PNL) ameliyatının sık görülen komplikasyonlarından birisi kanamadır. Bu retrospektif çalışma ile pediatrik PNL olgularında kanamayı etkileyen faktörlerin belirlenmesini amaçladık. Gereç ve Yöntemler: Ocak 2010 ve Mayıs 2018 tarihleri arasında kliniğimizde 57 çocuk hastaya (24 kız, 33 erkek) uygulanan 61 pediatrik PNL ameliyatının sonuçları retrospektif olarak değerlendirildi. Bulgular: Hasta popülasyonunun medyan yaşı 13 (2-19) olarak saptandı. Hastalarımızın medyan taş yükü 420 (78-2475) mm 2 iken, taşların %47,5'i kompleks taş özelliğindeydi. Hastaların %88,5'ine tek akses yapıldı ve akseslerin %83,6'sı infrakostal seviyeden gerçekleştirildi. PNL prosedürlerinden sonra ortalama hemoglobin ve hematokrit (Htc) düşüşü sırasıyla 1,1±1,15 mg/dl ve %3,23±3,26 olarak bulundu. Kan transfüzyonu yapılan hastalarda (n=4, %6,5) hemoglobin ve Htcʼde ortalama düşüş sırasıyla 3,1±0,8 mg/dl ve %10,3±2,8 olarak saptandı. Medyan operasyon süresi 90 (24-155) dk olarak saptandı. Çalışmamızda sadece operasyon süresinin uzun olması, pediatrik PNL olgularında artmış kan kaybıyla anlamlı olarak ilişkili bulundu (p<0.001). Sonuç: PNL düşük morbidite, yüksek başarı oranı ve kısa hastanede kalış süresi ile böbrek taşlarının tedavisi için kullanılan, minimal invaziv bir cerrahi tekniktir. Bu çalışmada operasyon süresinin uzamasının pediatrik PNL'de artmış kan kaybı riski ile birlikte olduğu sonucuna ulaştık.

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Comparison of Dilation Methods in Percutaneous Nephrolithotomy: Which One Is More Successful?

Abstract: None of the dilation methods was significantly superior in terms of surgical success, efficiency, or safety. Although balloon dilation was advantageous with respect to time parameters, the role of surgical experience should not be ignored.

Cited by 8 publications

References 19 publications

Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis

Balloon versus Amplatz for tract dilation in fluoroscopically guided percutaneous nephrolithotomy: a systematic review and meta-analysis

Updates in endourological management of urolithiasis

Investigation of Factors Affecting Bleeding in Children with Percutaneous Nephrolithotomy

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