Abstract
Background:
During percutaneous nephrolithotomy, one of the challenges that arise is when the tract dilatation fails due to short-advancement. In such cases, instead of creating a new tract, a method of endoscopic tract dilatation can be used as a salvage technique for renal access. In this study, we aimed to compare the efficacy of endoscopic tract dilatation with bi-prong forceps in cases of short access with uneventful dilatation using one-shot Amplatz tract dilatation.
Methods and Materials:
The study enrolled patients who underwent sonography-guided PCNL for six consecutive months in 2023. After renal puncture under the sonography guide, an Amplatz dilator was used for one-shot tract dilation. In the case of short-advancement, a bi-prong forceps was used under direct endoscopic vision for tract dilatation. The study compared the operation time, postoperative complications, and stone-free rate between successful one-shot Amplatz dilatation (SA) and those with salvage endoscopic tract dilatation (SE).
Results:
The study included 108 patients with a mean age of 47.9 ± 11.6 (50.9% male). Short-advancement occurred in 63 patients (58.3%) who were assigned to the (SE) group. The salvage technique was successful in 95.2% of occasions of short-advancement. Pre-operative demographic and clinical data were not different in this group compared to the (SA) group. The operative time was 21.1 ± 14.5 minutes in the (SE) group, which was not longer than the (SA) group with 22.7 ± 12.6 minutes (P = 0.2). The stone-free rate was 81.0% in the (SE) group, which was not inferior to 73% in the (SA) group (P = 0.3). The transfusion rate and complications were not different as well.
Conclusion:
Salvage endoscopic tract dilatation in case of short-advancement after one-shot Amplatz tract dilatation during percutaneous nephrolithotomy is not associated with higher complications or inferior clinical outcomes compared with cases with successful one-shot dilatation.