[Standard-tract percutaneous nephrolithotomy accessed by two-step dilation for 3052 patients]

Area of Science:

• Urology
• Nephrology
• Surgical Procedures

Background:

• Percutaneous nephrolithotomy (PNL) is a key procedure for kidney stone removal.
• Optimizing PNL techniques is crucial for improving efficacy and reducing patient morbidity.
• Two-step dilation offers a potential method to enhance access for PNL.

Purpose of the Study:

• To assess the effectiveness and safety of 24F-tract percutaneous nephrolithotomy (PNL) utilizing a two-step dilation approach.
• To evaluate the outcomes in a large cohort of patients undergoing this specific PNL technique.

Main Methods:

• A retrospective analysis of 3052 patients undergoing 24F-tract PNL with two-step dilation between 2003 and 2008.
• Inclusion of patients with complex renal anatomies, including solitary kidneys, cysts, horseshoe kidneys, and transplanted kidneys.
• Ultrasound-guided puncture was employed for tract access.

Main Results:

• A high one-session access success rate of 99.4% was achieved.
• The overall stone-free rate after one session was 72.3% for multiple/staghorn calculi, reaching 88.6% after secondary procedures.
• Morbidity was low, with 1.4% requiring transfusion and minimal instances of pneumothorax (0.5%) or urinary extravasation (0.5%).

Conclusions:

• 24F-tract PNL accessed by two-step dilation, guided by ultrasound, demonstrates significant efficacy in stone removal.
• The procedure is associated with a favorable safety profile, even in patients with challenging renal anatomies.
• This technique represents a viable and safe option for managing complex kidney stone burdens.