‘X-ray’-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy

Abstract

The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10 F fascial dilator was used to dilate the tract. Subsequently, the 6 F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication.

X-ray–free Ultrasound-guided Percutaneous Nephrolithotomy: How to Select the Right Patient?

“…These include the use of Teflon dilators 25 ; a small scope to confirm proper dilator placement 7 ; and more recently, balloon dilators to perform radiation-free US-guided PCNL. 26 All of these studies demonstrate the power of how US can be used to guide the process of renal tract dilation, a technical step of PCNL that has been relatively understudied.…”

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

“…There are few studies concerning balloon dilation method in totally ultrasound-guided PCNL in the literature. Ren et al compared the outcomes of PCNL using two tract dilation methods under unltrasound guidance and concluded that BD had a higher success rate of access creation and less blood loss [23].Zhou et al suggested that BD was preferable for beginners because it was associated with less hemorrhage complication compared with that of Amplatz dilation [24]. However, we failed to find any significant difference between two groups regarding blood loss and complication in this study; The Hb drop was mainly caused by hemodilution.…”

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

“…The steps of channel establishment are mainly divided into puncture and dilation, which requires the surgeon to accurately puncture and rapidly dilate [12,13]. Generally, puncture is guided in vitro by X-ray or US [12,14]. Since US is not only free from contrast agents, but also bene cial for identi cation of important blood vessels including renal artery, vein and arcuate arteries, we adopted US-guided puncture.…”