Annals of Nephrology

ISSN: 2642-4827

SHORT REVIEW | VOLUME 2 | ISSUE 1 OPEN ACCESS

Review of Literature for the Comparison of Dilatation Methods Using Percutaneous Nephrolithotomy

Sercan Sarı, Mehmet Çağlar Çakıcı, Hakkı Uğur Özok, Nihat Karakoyunlu, Hamit Ersoy

  • Sercan Sarı 1
  • Mehmet Çağlar Çakıcı 2*
  • Hakkı Uğur Özok 2
  • Nihat Karakoyunlu 2
  • Hamit Ersoy 2
  • Department of Urology, Sarikamis State Hospital, Turkey
  • Department of Urology, Diskapi Yildirim Beyazit Education and Research Hospital, Turkey

Sarı S, Çakıcı MC, Özok HU, et al. (2017) Review of Literature for the Comparison of Dilatation Methods Using Percutaneous Nephrolithotomy. Ann Nephrol 2(1):9-11.

Accepted: February 18, 2017 | Published Online: February 21, 2017

Review of Literature for the Comparison of Dilatation Methods Using Percutaneous Nephrolithotomy

Introduction


Kidney stone is an important issue in urology. The management is changed according to the size and location of kidney stone. There are some treatment modalities. The first choice in treatment of > 2 cm sized kidney stones is PNL [1]. PNL is first defined by Fernström, et al. in 1976 [2]. Its usage increased and took place of open surgery [1]. An important step of PNL is nephrostomy tract formation. This step affects bleeding risk, surgery time, success and complication rate [3]. Four different methods (Alken, Amplatz, Balloon, One-step) are used. In Balloon and One-step dilatation, process is made in one stage. In Alken and Amplatz dilatation, process is made small to bigger increasing diameter sequentially. There is no consensus about which one is the best [4]. In our study, we aimed to compare these methods in the light of certain parameters. We reviewed the literature while making the comparison. These parameters were efficiency, bleeding, scopy-operation time, complication and cost.

Efficiency


When looking literature, there are some factors effecting success. Patients characteristics, history of previous surgery (secondary), mobile kidney and experience of the surgeon affect success [5-7]. There is no statistically significant difference in success rates when we look at the studies comparing the dilatation methods in the literature [8]. In a study comparing Amplatz and Alken dilatation, the success rate was higher in Amplatz dilatation group and the difference was statistically significant [9]. Patient characteristics are different in the studies. In some studies, secondary patients, obese patients and patients using anticoagulant drugs were excluded. In secondary (having history of previous surgery) patients, dilatation gets difficult due to the scar tissue. In secondary patients, alken dilatation is recommended [10]. In a review, one step dilatation is recommended in case of open surgery history [8]. Alken dilatation is recommended in mobile kidneys [10]. In children, lower sized dilatation is needed. So amplatz dilatation is recommended in children [10]. Factors such as diabetes mellitus, body mass index and hypertension were not evaluated in literature. In table 1 we showed the studies comparing the dilatation methods for efficiency.

Bleeding


Bleeding is a complication seen in PNL. Bleeding can be seen 0 to 25% independent of dilatation method [11]. There are some factors affecting bleeding. There are some views about bleeding during nephrostomy tract formation. In a study, it is reported that half of the bleeding is related to dilatation method [12]. In some studies it is reported that there is not any relation between bleeding and dilatation method [3,13]. Akman, et al. reported that the most important factor affecting bleeding is stone type [14]. Yamaguchi, et al. reported that size of the sheath, stone burden, operation time and case burden affect bleeding [15]. In studies comparing amplatz and balloon dilatation, there is lower bleeding rates in balloon dilatation group. The difference was not statistically significant [6,16,17]. In studies comparing balloon and alken dilatation methods, bleeding is higher in balloon dilatation group and the difference was statistically significant [4,11,15,18]. In studies comparing one step and metal dilatation methods, bleeding rate was lower in one step group [18-21]. In a study comparing amplatz, alken and balloon dilatation, there is no difference in bleeding rates [3]. In alken dilatation method, metal dilatators apply continuous pressure to small vessels. This effect is not seen in amplatz dilatation.Also bleeding risk increases during changing dilatators [10]. In table 2 we showed the studies comparing the dilatation methods for bleeding.

Operation & Scopy Time


In a study comparing amplatz, alken and balloon dilatation methods, operation and scopy time were statistically significantly lower in balloon dilatation group. The difference was related to tract formation time [3]. In the studies comparing amplatz and balloon dilatation methods, there was no difference in operation time [6,16,17]. In the studies comparing alken and amplatz dilatation methods, there is not statistically significant difference in operation and scopy time [9,10].

Complication


When evaluating complications, there is not statistically significant difference for complications in the studies comparing the dilatation methods. In a study comparing alken and amplatz dilatation methods, minor complications were statistically significantly higher in alken dilatation group [9].

Cost


When we evaluate the cost, from cheap to expensive we can put in order as alken-amplatz and balloon dilatation [21]. Alken dilatation set is reusable. So its cost is low. Amplatz dilatators can be resterilized. But its quality may decrease [10].

Conclusion


In conclusion, there is not a consensus about which one is the optimum method. Prospective, high patient number and including detailed patient characteristics studies are needed about dilatation methods.

Funding


We have no financial relationship in this study.

Conflict of Interest


The authors declare that they have no conflict of interest.

References


  1. Turk C, Knoll T, Patrik A, et al. (2012) Guidelines on Urolithiasis, EAU Guidelines, edition presented at the 27th EAU Annual Congress, Paris.
  2. Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 10: 257-259.
  3. Nalbant Ismail, Karakoyunlu Ahmet Nihat, Yesil Suleyman, et al. (2016) Journal of Laparoendoscopic & Advanced Surgical Techniques 26: 478-482.
  4. Lopes T, Sangam K, Alken P, et al. (2011) The Clinical Research Office of the Endourological Society. Percutaneous Nephrolithotomy global study:Tract dilation comparisons in 5537 patients. J Endourol 25: 755-762.
  5. Joel AB, Rubenstein JN, Hsieh MH, et al. (2005) Failed percutaneous balloon dilation for renal access: Incidence and risk factors. Urology 66: 29-32.
  6. Safak M, Gogus C, Soygur T (2003) Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: experience with 95 cases and comparison with the fascial dilator system. Urol Int 71: 382-384.
  7. Kumar V, Keely FX (2008) Percutaneous nephrolithotomy: Why do we use rigid dilators? J Endourol 22: 1877-1879.
  8. Dehong C, Liangren L, Huawei L, et al. (2013) A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 41: 523-530.
  9. Hijazi S, Echtle D, Hasselhof VM, et al. (2016) Metal telescopic and Amplatz sheath dilation in nephrolithotomy. Urol Ann 8: 66-69.
  10. Ozok HU, Sagnak L, Senturk AB, et al. (2012) A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. J Endourol 26: 630-634.
  11. Wezel F, Mamoulakis C, Rioja J, et al. (2009) Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 23: 1655-1661.
  12. Kessaris DN, Bellman GC, Pardalidis NP, et al. (1995) Management of hemorrhage after percutaneous renal surgery. J Urol 153: 604-608.
  13. Stoller ML, Wolf JS Jr, St Lezin MA (1994) Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 152: 1977-1981.
  14. Akman T, Binbay M, Sari E, et al. (2011) Factors affecting bleeding during percutaneous nephrolithotomy: Single surgeon experience. J Endourol 25: 327-333.
  15. Yamaguchi A, Skolarikos A, Buchholz NP, et al. (2011) Operating times and bleeding complications in percutaneous nephrolithotomy: A comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 25: 933-939.
  16. Davidoff R, Bellman GC (1997) Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 157: 1229-1231.
  17. Gonen M, Istanbulluoglu OM, Cicek T, et al. (2008) Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation. J Endourol 22: 901-904.
  18. Frattini A, Barbieri A, Salsi P, et al. (2001) One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 15: 919-923.
  19. Amjadi M, Zolfaghari A, Elahian A, et al. (2008) Percutaneousnephrolithotomy in patients with previous open nephrolithotomy:one-shot versus telescopic technique for tract dilatation. J Endourol 22: 423-425.
  20. Falahatkar S, Neiroomand H, Akbarpour M, et al. (2009) One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and effi-cacy. J Endourol 23: 615-618.
  21. Aminsharifi A, Alavi M, Sadeghi G, et al. (2011) Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial. J Endourol 25: 927-931.

References

  1. Turk C, Knoll T, Patrik A, et al. (2012) Guidelines on Urolithiasis, EAU Guidelines, edition presented at the 27th EAU Annual Congress, Paris.
  2. Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 10: 257-259.
  3. Nalbant Ismail, Karakoyunlu Ahmet Nihat, Yesil Suleyman, et al. (2016) Journal of Laparoendoscopic & Advanced Surgical Techniques 26: 478-482.
  4. Lopes T, Sangam K, Alken P, et al. (2011) The Clinical Research Office of the Endourological Society. Percutaneous Nephrolithotomy global study:Tract dilation comparisons in 5537 patients. J Endourol 25: 755-762.
  5. Joel AB, Rubenstein JN, Hsieh MH, et al. (2005) Failed percutaneous balloon dilation for renal access: Incidence and risk factors. Urology 66: 29-32.
  6. Safak M, Gogus C, Soygur T (2003) Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: experience with 95 cases and comparison with the fascial dilator system. Urol Int 71: 382-384.
  7. Kumar V, Keely FX (2008) Percutaneous nephrolithotomy: Why do we use rigid dilators? J Endourol 22: 1877-1879.
  8. Dehong C, Liangren L, Huawei L, et al. (2013) A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 41: 523-530.
  9. Hijazi S, Echtle D, Hasselhof VM, et al. (2016) Metal telescopic and Amplatz sheath dilation in nephrolithotomy. Urol Ann 8: 66-69.
  10. Ozok HU, Sagnak L, Senturk AB, et al. (2012) A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. J Endourol 26: 630-634.
  11. Wezel F, Mamoulakis C, Rioja J, et al. (2009) Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 23: 1655-1661.
  12. Kessaris DN, Bellman GC, Pardalidis NP, et al. (1995) Management of hemorrhage after percutaneous renal surgery. J Urol 153: 604-608.
  13. Stoller ML, Wolf JS Jr, St Lezin MA (1994) Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 152: 1977-1981.
  14. Akman T, Binbay M, Sari E, et al. (2011) Factors affecting bleeding during percutaneous nephrolithotomy: Single surgeon experience. J Endourol 25: 327-333.
  15. Yamaguchi A, Skolarikos A, Buchholz NP, et al. (2011) Operating times and bleeding complications in percutaneous nephrolithotomy: A comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 25: 933-939.
  16. Davidoff R, Bellman GC (1997) Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 157: 1229-1231.
  17. Gonen M, Istanbulluoglu OM, Cicek T, et al. (2008) Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation. J Endourol 22: 901-904.
  18. Frattini A, Barbieri A, Salsi P, et al. (2001) One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 15: 919-923.
  19. Amjadi M, Zolfaghari A, Elahian A, et al. (2008) Percutaneousnephrolithotomy in patients with previous open nephrolithotomy:one-shot versus telescopic technique for tract dilatation. J Endourol 22: 423-425.
  20. Falahatkar S, Neiroomand H, Akbarpour M, et al. (2009) One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and effi-cacy. J Endourol 23: 615-618.
  21. Aminsharifi A, Alavi M, Sadeghi G, et al. (2011) Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial. J Endourol 25: 927-931.