Abstract
To determine the magnitude of renal displacement (a major cause of access failure or loss) during the renal access steps in percutaneous nephrolithotomy (PCNL), investigate predictors of excessive renal displacement, and compare the effect of one-stage versus gradual dilation on renal displacement during access. Sixty-six adult patients undergoing PCNL were randomized into two groups containing 33 patients each: Group 1 underwent gradual tract dilation with Alken metal dilators, and Group 2 received one-stage tract dilation. In each patient, maximum renal displacement was measured in three planes (cephalocaudal, anteroposterior, and mediolateral) during the three access steps (needle puncture, Alken guide insertion, and dilator advancement). The patients’ demographic data and intraoperative parameters were compared. In both groups, net renal displacement during the three access steps was in the cephalad, medial, and anterior directions. There were no significant differences in the magnitude of renal displacement in patients with gradual versus one-stage tract dilation. Renal displacement was significantly more pronounced in all planes and in all access steps in female patients and in those with no previous history of open stone surgery on the ipsilateral kidney. High body mass index (BMI) showed a significant negative correlation with cephalad and anterior renal displacement, but not with medial displacement. Three-dimensional movement of the kidney during percutaneous access in PCNL is similar when gradual versus one-stage tract dilation is used. Inherent patient characteristics, such as female sex, BMI, and a previous ipsilateral flank scar are major determinants of the magnitude of renal displacement during the PCNL access steps.
Similar content being viewed by others
References
Miller NL, Matlaga BR, Lingeman JE (2007) Techniques for fluoroscopic percutaneous renal access. J Urol 178(1):15–23
Ko R, Soucy F, Denstedt JD, Razvi H (2008) Percutaneous nephrolithotomy made easier: a practical guide, tips and tricks. BJU Int 101:535–539
Ziaee SA, Karami H, Aminsharifi A, Mehrabi S, Zand S, Javaherforooshzadeh A (2007) One-stage tract dilation for percutaneous nephrolithotomy: is it justified? J Endourol 21:1415–1420
Aminsharifi A, Alavi M, Sadeghi G, Shakeri S, Afsar F (2011) Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial. J Endourol 25:927–931
Wolf JS (2012) Percutaneous approaches to the upper urinary tract collecting system. In: Wein AJ, Kavoussi LR (eds) Campbell-Walsh urology, 10th edn. Saunders Elsevier, Philadelphia, pp 1324–1356
El-Assmy AM, Shokeir AA, Mohsen T, El-Tabey N, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA (2007) Renal access by urologist or radiologist for percutaneous nephrolithotomy—is it still an issue? J Urol 178:916–920
Tepeler A, Armağan A, Akman T, Polat EC, Ersöz C, Topaktaş R, Erdem MR, Onol SY (2012) Impact of percutaneous renal access technique on outcomes of percutaneous nephrolithotomy. J Endourol 26:828–833
Falahatkar S, Asgari SA, Nasseh H, Allahkhah A, Farshami FJ, Shakiba M, Esmaeili S (2011) Kidney displacement in complete supine PCNL is lower than prone PCNL. Urol Res 39:159–164
Gofrit ON, Shapiro A, Donchin Y, Bloom AI, Shenfeld OZ, Landau EH, Pode D (2002) Lateral decubitus position for percutaneous nephrolithotripsy in the morbidly obese or kyphotic patient. J Endourol 16:383–386
El-Assmy AM, Shokeir AA, El-Nahas AR, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA (2007) Outcome of percutaneous nephrolithotomy: effect of body mass index. Eur Urol 52:199–204
Acknowledgments
This work was supported by Shiraz University of Medical Sciences. We thank V. Saberzadeh for producing the supplemental video and Celine Cavallo (AuthorAID in the Eastern Mediterranean) for improving the use of English in the manuscript.
Conflict of interest
The authors have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Supplementary material 1 (MPG 31288 kb)
Rights and permissions
About this article
Cite this article
Aminsharifi, A., Haghpanah, R. & Haghpanah, S. Predictors of excessive renal displacement during access in percutaneous nephrolithotomy: a randomized clinical trial. Urolithiasis 42, 61–65 (2014). https://doi.org/10.1007/s00240-013-0600-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-013-0600-9