A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy

Area of Science:

• Urology
• Surgical Techniques
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Dilation of the collecting system is a critical step in achieving PCNL access.
• Various dilation techniques exist, each with potential differences in safety, efficacy, and cost.

Purpose of the Study:

• To compare the safety, efficacy, and cost-effectiveness of one-shot dilation (OSD) against telescopic Alken, fascial Amplatz, and balloon dilation (BD) methods.
• To evaluate the impact of different dilation techniques on intraoperative parameters like X-ray exposure and access time.

Main Methods:

• A randomized controlled trial involving 480 patients undergoing PCNL.
• Patients were equally randomized into four groups, each receiving a different dilation technique.
• Comprehensive assessment of preoperative, intraoperative, and postoperative parameters up to 3 months, including access time, X-ray exposure, hemoglobin drop, complications, and success rates.

Main Results:

• No significant differences were observed in access time, hemoglobin drop, complication rates, or success rates among the four dilation groups.
• Both one-shot dilation (OSD) and balloon dilation (BD) significantly reduced X-ray exposure time compared to telescopic Alken and fascial Amplatz dilation.
• Balloon dilation (BD) was identified as the most expensive dilation method.

Conclusions:

• All four dilation techniques (OSD, BD, telescopic Alken, fascial Amplatz) demonstrate comparable safety and effectiveness in PCNL.
• OSD and BD offer the advantage of reduced fluoroscopy time during the dilation process.
• One-shot dilation (OSD) presents a more cost-effective option than balloon dilation (BD), positioning it as a potentially preferred method, particularly in resource-limited settings.