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Urinary Tract Calculi VI: Surgical Management

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...

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Percutaneous Nephrolithotomy Using Split Amplatz Sheath: A Randomized Clinical Trial.

Ali Tabibi¹, Amir Reza Abedi², Mohammad Hadi Radfar¹

¹Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran,Iran.

Urology Journal

|September 1, 2016

Summary

The split Amplatz sheath in percutaneous nephrolithotomy (PCNL) aids in extracting larger kidney stones, potentially reducing operative times and improving stone-free rates, especially for complex staghorn calculi.

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Area of Science:

Urology
Minimally Invasive Surgery
Nephrolithotomy

Background:

Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
The choice of Amplatz sheath (intact vs. split) may influence procedural outcomes.

Purpose of the Study:

To compare the efficacy and outcomes of PCNL using an intact Amplatz sheath versus a split Amplatz sheath.
To evaluate the impact of sheath type on stone extraction, operative time, and complications.

Main Methods:

A randomized study involving 72 patients undergoing PCNL.
Patients were divided into two groups: intact Amplatz sheath (group 1) and split Amplatz sheath (group 2).
Key metrics included operative time, stone size, fluoroscopy and lithotripsy duration, and postoperative serum biochemistry.

Main Results:

No significant differences in preoperative characteristics or minor complications between groups.
The split sheath group showed a trend towards higher stone-free rates (88.1% vs. 83.3%), significantly in staghorn stones and large calculi (>1000 mm²).
The split sheath facilitated extraction of significantly larger stones and was associated with shorter operative, lithotripsy, and fluoroscopy times.

Conclusions:

The split Amplatz sheath is advantageous in PCNL for facilitating the removal of larger kidney stones.
This approach may lead to reduced operative time, lithotripsy, and fluoroscopy exposure.
Split sheaths show promise for complex stone burdens, including staghorn calculi.