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Tract dilation monitored by ultrasound in percutaneous nephrolithotomy: feasible and safe

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Abstract

Purpose

To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this technique.

Methods

Patients who underwent PCNL with only one access (24 Fr) using the balloon dilator or sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to May 2018 in Beijing Tsinghua Changgung Hospital were retrospectively reviewed. Patients’ demographic information, intra- and postoperative data were analyzed. Factors which would increase the success rate of ultrasound-guided balloon dilation were investigated by logistic regression analysis.

Results

There were 986 PCNLs performed. 207 cases underwent balloon dilation, while 411 underwent sequential dilation. The two groups did not significantly differ in age, sex, BMI, stone diameter, access location, operation time, postoperative complication rate, and stone-free rate. The balloon dilation group comprised 207 patients (115 males, 92 females) with a mean age of 51 ± 10 years. Mean BMI was 25.2 ± 3.3 kg/m2. Mean stone size was 3.6 ± 1.2 cm, 47.3% of which were staghorn stones. Hydronephrosis of the targeted calyx occurred in 78.3% of patients. Within the balloon dilation group, tract dilation failed in 24 cases (11.6%) on the first attempt. The successful and failed subgroups had comparable outcomes. Multivariate analysis revealed that the risk factors for the failure of access establishment were the presence of staghorn stones (p = 0.032), prior ipsilateral open nephrolithotomy (p = 0.026), and lower pole access (p = 0.039), while the success rate was significantly higher in those with a hydronephrotic target calyx (p = 0.001).

Conclusions

Tract dilation using balloon catheter can be safely monitored by ultrasound, and is most suited to patients with a hydronephrotic target calyx.

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Acknowledgements

We thank Kelly Zammit, BVSc, from Liwen Bianji, Edanz Editing China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript.

Funding

This study was supported by the Capital Health Research and Development of Special (No. 2016-1-2241) and Beijing Municipal Science and Technology Commission (No. 12016B3003).

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Authors and Affiliations

  1. Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China

    Shu Wang, Xin Zhang, Yuzhe Tang, Bo Xiao, Weiguo Hu, Song Chen & Jianxing Li

  2. Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA

    Shu Wang

  3. University of North Carolina at Chapel Hill, Chapel Hill, USA

    Yitian Zhang

Authors
  1. Shu Wang
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  2. Yitian Zhang
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  3. Xin Zhang
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  4. Yuzhe Tang
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  5. Bo Xiao
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  6. Weiguo Hu
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  7. Song Chen
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  8. Jianxing Li
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Contributions

SW: data collection and management, manuscript writing and editing; YTZ: data analysis and manuscript editing; XZ: data management and manuscript editing; YZT: data collection and management; BX: data collection and management; WGH: data management; SC: data management; JXL: project development.

Corresponding author

Correspondence to Jianxing Li.

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The authors declare that they have no conflict of interest.

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The protocol was approved by the institutional ethic committee.

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Wang, S., Zhang, Y., Zhang, X. et al. Tract dilation monitored by ultrasound in percutaneous nephrolithotomy: feasible and safe. World J Urol 38, 1569–1576 (2020). https://doi.org/10.1007/s00345-019-02876-7

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  • DOI: https://doi.org/10.1007/s00345-019-02876-7

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