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Ding M, Zhu K, Zhang W, Huang H, Duan B, Zheng J, Wang H, Wang T, Bai P, Bin C. Comparing Balloon Dilation to Non-Balloon Dilation for Access in Ultrasound-Guided Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Int Braz J Urol 2024; 50:7-19. [PMID: 38166218 PMCID: PMC10947654 DOI: 10.1590/s1677-5538.ibju.2023.0373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024] Open
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of ultrasound-guided balloon dilation compared to non-balloon dilation for percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS A systematic review and meta-analysis were conducted by searching PubMed, EMBASE, and the Cochrane Library. Results were filtered using predefined inclusion and exclusion criteria as described and meta-analysis was performed using Review Manager 5.4 software. RESULTS A total of six studies involving 1189 patients who underwent PCNL were included. The meta-analysis results demonstrated that compared to non-balloon dilation, balloon dilation was associated with reduced haemoglobin drop [mean difference (MD) = -0.26, 95% CI = -0.40 ~ -0.12, P = 0.0002], decreased transfusion rate [odds ratio (OR) = 0.47, 95% CI = 0.24 ~ 0.92, P = 0.03], shorter tract establishment time (MD = -1.30, 95% CI = -1.87 ~ -0.72, P < 0.0001) and shorter operation time (MD = -5.23, 95% CI = -10.19 ~ -0.27, P = 0.04). CONCLUSIONS Overall, ultrasound-guided balloon dilatation offered several advantages in PCNL procedures. It facilitated faster access establishment, as evidenced by shorter access creation time. Additionally, it reduced the risk of kidney injury by minimizing postoperative haemoglobin drop and decreasing the need for transfusions. Moreover, it enhanced the efficiency of surgery by reducing the operation time. However, it is important to note that the quality of some included studies was subpar, as they did not adequately control for confounding factors that may affect the outcomes. Therefore, further research is necessary to validate and strengthen these findings.
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Affiliation(s)
- Meixuan Ding
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Kai Zhu
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Wenzhao Zhang
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineWomen and Children's HospitalXiamenChinaDepartment of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
| | - Haichao Huang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bo Duan
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Jiaxin Zheng
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Huiqiang Wang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Tao Wang
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Peide Bai
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chen Bin
- Fujian Medical UniversityThe School of Clinical MedicineFuzhouChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, China
- Xiamen UniversitySchool of MedicineThe First Affiliated Hospital of Xiamen UniversityXiamenChinaThe Key Laboratory of Urinary Tract Tumors and Calculi, Department of Urology Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
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Memik O, Voyvoda B, Ustuner M, Karsli O, Halat AO, Ozcan L. What is the safe and effective dilator number during access in PCNL? Three-shot dilation versus classical sequential Amplatz dilation. BMC Urol 2023; 23:197. [PMID: 38031043 PMCID: PMC10687924 DOI: 10.1186/s12894-023-01368-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
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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Affiliation(s)
- Omur Memik
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey.
| | - Bekir Voyvoda
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Murat Ustuner
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Onur Karsli
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Ahmed Omer Halat
- Department of Urology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Lojman Sokak, Derince, Kocaeli, 41900, Turkey
| | - Levent Ozcan
- Department of Urology, University of Health Sciences, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
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Masood Y, Iqbal N, Farooq RM, Iqbal S, Khan F. Intraoperative flexible nephroscopy during percutaneous nephrolithotomy: An 8 years' experience. Pak J Med Sci 2021; 37:716-720. [PMID: 34104154 PMCID: PMC8155419 DOI: 10.12669/pjms.37.3.3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objectives: To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate. Methods: We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups. Results: The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups. Conclusions: Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones.
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Affiliation(s)
- Yasir Masood
- Yasir Masood Resident Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Nadeem Iqbal
- Nadeem Iqbal Urology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Sajid Iqbal
- Sajid Iqbal Department of Rehabilitation, PNS Hospital, Karachi, Pakistan
| | - Faheemullah Khan
- Faheemullah Khan Resident Diagnostic Radiology, Aga Khan University Hospital, Karachi, Pakistan
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Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, Ye Z, Wang S. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol 2018; 50:807-817. [PMID: 29556901 DOI: 10.1007/s11255-018-1847-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.
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Affiliation(s)
- Chao Wei
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China.
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