One-stage tract dilation for percutaneous nephrolithotomy: is it justified?

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Optimizing PCNL tract dilation is crucial for efficiency and patient outcomes.
• Previous renal scarring can complicate tract creation.

Purpose of the Study:

• To evaluate the feasibility of one-stage acute tract dilation using a 30F Amplatz dilator for PCNL.
• To determine if this approach is effective in patients with and without previous renal scarring.
• To assess if the one-stage method enhances procedural efficiency and cost-effectiveness.

Main Methods:

• Prospective analysis of 100 consecutive patients undergoing one-stage tract dilation for PCNL.
• Patients were divided into two groups: 46 with prior ipsilateral open stone surgery (OSS) and 54 without.
• Key metrics included access success rate, operative time, radiation exposure, and bleeding complications.

Main Results:

• A 93% success rate was achieved for entering the targeted calix with the one-stage technique.
• No significant difference in success rates was observed between patients with (93.5%) and without (92.6%) prior OSS.
• Previous OSS did not negatively affect access time, radiation exposure, or bleeding complications; no major injuries occurred.

Conclusions:

• One-stage tract dilation for PCNL is a safe and highly effective method.
• This technique is applicable to nearly all adult patients, simplifying PCNL procedures.
• The approach offers potential for reduced procedure time and costs.