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A Comparison of the Alken Metallic Telescopic Dilator and Amplatz Serial Dilator for Renal Access in Percutaneous
Amitkumar Khwairakpam1, Somarendro Khumukcham Singh1, Pratik Sharan1
1Urology, Regional Institute of Medical Sciences, Imphal, IND.
Insights
The Alken dilator offers safer percutaneous nephrolithotomy (PCNL) with less bleeding and lower pain scores compared to the Amplatz dilator. Both methods achieve similar stone clearance rates in PCNL procedures.
Area of Science:
- Urology
- Surgical Technology
- Nephrolithiasis Management
Background:
- Percutaneous nephrolithotomy (PCNL) requires precise renal calyx access, a critical step with varied dilatation techniques.
- No established consensus exists regarding the optimal method for access tract dilatation in PCNL.
Purpose of the Study:
- To compare the safety and efficacy of Alken metallic dilators versus Amplatz dilators for renal access during PCNL.
- To evaluate key safety parameters including bleeding, transfusion rates, access time, and postoperative complications.
Main Methods:
- Retrospective review of 80 patients undergoing PCNL between March 2023 and February 2024.
- Patients divided into two groups: Alken dilator (n=42) and Amplatz dilator (n=38).
- Comparison of safety metrics (bleeding, transfusion, access time, fever, urosepsis) and efficacy (access success, stone clearance).
Main Results:
- Alken dilator group showed significantly shorter access time (7.3 vs. 8.1 mins, p=0.012).
- Amplatz dilator group experienced higher intraoperative bleeding (15.7% vs. 4.7%), greater hemoglobin drop (1.3 vs. 0.7 g/dl), and increased need for blood transfusion (18.4% vs. 7.14%).
- Higher incidence of postoperative urosepsis and VAS scores observed in the Amplatz dilator group, while stone clearance was comparable.
Conclusions:
- Alken dilators are associated with reduced blood transfusion rates and lower postoperative pain scores (VAS) in PCNL.
- Amplatz dilators were linked to a higher occurrence of postoperative urosepsis.
- Both Alken and Amplatz dilators demonstrated comparable efficacy in achieving successful renal access and stone clearance.
Background:
Access to the renal calyx is a challenging and crucial step for a successful percutaneous nephrolithotomy (PCNL). There are different methods of access tract dilatation, and there is no consensus on which method is the best. We conducted a comparative retrospective study on the safety and efficacy of the Alken metallic dilator and Amplatz dilator for renal access in PCNL.
Methods:
We retrospectively reviewed the medical records of 80 patients who underwent PCNL between March 2023 and February 2024, and they were divided into two groups. Group A (n=42) comprised patients where Alken dilators were used, while group B (n=38) comprised patients where Amplatz dilators were used. Safety parameters, that is, perioperative bleeding, blood transfusion, access time, postoperative fever, and urosepsis, were compared between the groups. Efficacy in terms of successful renal access and stone clearance was also compared.
Results:
The mean access time (mins) was longer in group B than group A (8.1 vs. 7.3, p=0.012). The intraoperative bleeding was more in group B (15.7% vs. 4.7%, p<0.001). Group B had more hemoglobin (g/dl) drop (1.3 vs. 0.7, p<0.001) and need for blood transfusion (18.4% vs. 7.14%, p<0.001) and VAS score (p<0.001) than group A. Postoperative urosepsis was more common in group B. Efficacy in terms of successful renal access and stone clearance was comparable.
Conclusion:
The Alken dilator group has a lower rate of blood transfusion and postoperative VAS score. The Amplatz dilator group had more incidences of postoperative urosepsis. The efficacy in both groups was comparable.
