AI Article Synopsis
- A study was conducted to compare two methods of dilation during percutaneous nephrolithotomy (PCNL) for kidney stones: the conventional sequential Amplatz dilation (SAD) using ten dilators and a new three-shot dilation (3SD) method using only three dilators.
- The research involved 283 patients and found that the 3SD method significantly reduced fluoroscopy and operation times, with a notable decrease in hemoglobin levels but similar blood transfusion needs between the groups.
- Both methods had similar stone-free rates, indicating that the 3SD approach is effective for improving efficiency without compromising safety in kidney stone procedures.
Article Abstract
Background: Although PCNL has been used for a long time to treat nephrolithiasis, there is still contradictory information concerning the use of the dilation method. In this study, we aimed to compare conventional sequential Amplatz dilatation (SAD) using ten dilators and a method using three dilators (12, 20, and 30 Fr), which we named "three-shot dilatation" (3SD), in terms of fluoroscopy time (FT), operation time, bleeding and stone-free rates.
Methods: The study included patients who underwent PCNL with the SAD and 3SD methods. A different surgeon with extensive endourology experience applied each technique. One of the surgeons operated on the patients using the SAD method with ten dilators, and the other surgeon performed the operations using the 3SD method involving three Amplatz dilators (12, 20, and 30 Fr).
Results: A total of 283 patients, 138 in the 3SD group and 145 in the SAD group, were included in the study. The mean age of the patients was 47.32 ± 13.71 years. There was no statistically significant difference between the two groups regarding preoperative characteristics (p > 0.05). The FTs of access 2, total access, and total operation were significantly shorter in the 3SD group (p = 0.0001). The decrease in hemoglobin was statistically significant in the 3SD group compared to the SAD group (p = 0.022), while the blood transfusion requirements of the groups were similar (p = 0.176). There was no statistically significant difference between the two groups regarding stone-free rates (p = 0.973). In four patients in the SAD group, re-access was necessary due to the loss of passage due to the guide wire slipping out of its place.
Conclusion: Intraoperative FT can be shortened using the described 3SD method without compromising surgical safety. However, this method can be used as an intermediate step in the transition to one-shot dilation by surgeons experienced in performing SAD.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687924 | PMC |
| http://dx.doi.org/10.1186/s12894-023-01368-6 | DOI Listing |
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