The use of the amplatz sheath in percutaneous nephrolithotomy: does amplatz sheath size matter?

To evaluate the effect of Amplatz sheath size used in percutaneous nephrolithotomy (PCNL) on postoperative outcome, bleeding, and renal impairment rates.

One-hundred and ten patients who underwent uneventful percutaneous nephrolithotomy between November 2011 and October 2012 were included in the study. The patients were divided into 5 groups based on Amplatz sheath size (22, 24, 26, 28 and 30 Fr). Groups were comppared in terms of pre- and post-operative mean hemoglobin, creatinine, nephrostomy time, nephrostomy tube diameter, operative time, and fluoroscope time.

Mean operative time, preoperative hemoglobin and creatinine values were similar in all groups. Postoperative mean hemoglobin level was significantly lower and postoperative mean creatinine level was significantly higher in patients who were treated with a larger Amplatz sheath when compared to a smaller size (p < 0.05). It was observed that nephrostomy time and nephrostomy tube size significantly increased as the Amplatz sheath size increased. Seven patients presented with postoperative infection (1, 2, 1, 0 and 3 patients in Group I, II, III, IV, and V respectively), 13 patients presented with bleeding requiring blood transfusion (2, 4, and 7 patients in Group III, IV, and V respectively), and residual stone was observed in 9 patients (5, 2, 0, 1, and 1 patients in Group I, II, III, IV, and V respectively).

Although the use of a larger Amplatz sheath for larger stones seems to be suitable, this is not the case for smaller stones. For smaller stones, a smaller Amplatz sheath size would be useful to decrease the bleeding and renal impairment rates.