Chinese One-shot Dilation versus Sequential Fascial Dilation for Percutaneous Nephrolithotomy: A Feasibility Study and Comparison

Jing Xiong, Ying Shi, Xiaoping Zhang, Yifei Xing, Wencheng Li



Purpose: Nephrostomy tract creation is a key step to perform a successful percutaneous nephrolithotomy (PCNL). In an attempt to improve the conventional technique of the tract dilation, a Chinese one-shot dilation was developed and compared with the sequential fascial dilation.

Materials and Methods: We retrospectively reviewed medical records of 116 patients who had undergone 116 PCNL in our department from January 2012 to December 2012. The nephrostomy tracts had been created by using Chinese one-shot (one-shot group, 59 cases) or sequential fascial dilation technique (sequential group, 57 cases). Tract creation time, hemorrhage loss, overall renal function, tract dilation failure and major complications were compared between the two groups.

Results: The one-shot group had a significantly shorter mean (SD) tract creation time (1.9±0.4 vs 4.6±0.9 min, P<0.001) and lower mean (SD) decrease in hemoglobin concentration (0.59±0.32 vs 0.68±0.37 g/dL, P=0.0009) compared to the sequential group, respectively. There were no significant differences in mean (SD) value changes of pre- and post-operative serum creatine concentrations (4.6±11.3 vs 4.9±14.7 ?mol/L, P=0.259) between the one-shot and sequential group. No tract dilation failure or major complications occurred in both of the groups.

Conclusion: This study demonstrated that the Chinese one-shot dilation technique is as safe and feasible as the conventional sequential fascial dilation. Furthermore, a greater reduction in tract creation time and blood loss was achieved using this technique.



Full Text:




Miller NL, Lingeman JE. Management of kidney stones. Bmj. 2007;334(7591):468-72.

Yamaguchi A, Skolarikos A, Buchholz NP, Chomon GB, Grasso M, Saba P, et al. 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. Journal of endourology. 2011;25(6):933-9.

Antonelli JA, Pearle MS. Advances in percutaneous nephrolithotomy. Urol Clin North Am. 2013;40(1):99-113.

Ozok HU, Sagnak L, Senturk AB, Karakoyunlu N, Topaloglu H, Ersoy H. A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilation in percutaneous nephrolithotomy. Journal of endourology. 2012;26(6):630-4.

Alken P, Hutschenreiter G, Gunther R, Marberger M. Percutaneous stone manipulation. J Urol. 1981;125(4):463-6.

Castaneda-Zuniga WR, Clayman R, Smith A, Rusnak B, Herrera M, Amplatz K. Nephrostolithotomy: percutaneous techniques for urinary calculus removal. AJR American journal of roentgenology. 1982;139(4):721-6.

Rusnak B, Castaneda-Zuniga W, Kotula F, Herrera M, Amplatz K. An improved dilator system for percutaneous nephrostomies. Radiology. 1982;144(1):174.

Clayman RV, Castaneda-Zuniga WR, Hunter DW, Miller RP, Lange PH, Amplatz K. Rapid balloon dilatation of the nephrostomy track for nephrostolithotomy. Radiology. 1983;147(3):884-5.

Aminsharifi A, Alavi M, Sadeghi G, Shakeri S, Afsar F. Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial. Journal of endourology. 2011;25(6):927-31.

Travis DG, Tan HL, Webb DR. Single-increment dilatation for percutaneous renal surgery: an experimental study. British journal of urology. 1991;68(2):144-7.

Ziaee SA, Karami H, Aminsharifi A, Mehrabi S, Zand S, Javaherforooshzadeh A. One-stage tract dilation for percutaneous nephrolithotomy: is it justified? J Endourol. 2007;21(12):1415-20.

Wezel F, Mamoulakis C, Rioja J, Michel MS, de la Rosette J, Alken P. Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. Journal of endourology. 2009;23(10):1655-61.

Shen CH, Cheng MC, Lin CT, Jou YC, Chen PC. Innovative metal dilators for percutaneous nephrostomy tract: report on 546 cases. Urology. 2007;70(3):418-21; discussion 21-2.

de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, et al. The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. Journal of endourology. 2011;25(1):11-7.

Frattini A, Barbieri A, Salsi P, Sebastio N, Ferretti S, Bergamaschi E, et al. One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol. 2001;15(9):919-23.

Falahatkar S, Neiroomand H, Akbarpour M, Emadi SA, Khaki N. One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and efficacy. J Endourol. 2009;23(4):615-8.

Shi Y, Liang HG, Yang X, Hai B, Wang L, Xing YF, et al. Ultrasonography-guided percutaneous nephrolithotomy with Chinese one-shot tract dilation technique based on stimulated diuresis: A report of 67 cases. Journal of Huazhong University of Science and Technology Medical sciences = Hua zhong ke ji da xue xue bao Yi xue Ying De wen ban = Huazhong keji daxue xuebao Yixue Yingdewen ban. 2016;36(6):881-6.

de la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrolithotomy--a critical review. Eur Urol. 2008;54(5):994-1001.

Amjadi M, Zolfaghari A, Elahian A, Tavoosi A. Percutaneous nephrolithotomy in patients with previous open nephrolithotomy: one-shot versus telescopic technique for tract dilatation. J Endourol. 2008;22(3):423-5.

Sofikerim M, Demirci D, Gulmez I, Karacagil M. Does previous open nephrolithotomy affect the outcome of percutaneous nephrolithotomy? Journal of endourology. 2007;21(4):401-3.

Kurtulus F, Fazlioglu A, Tandogdu Z, Karaca S, Salman Y, Cek M. Analysis of factors related with bleeding in percutaneous nephrolithotomy using balloon dilatation. The Canadian journal of urology. 2010;17(6):5483-9.

Akman T, Binbay M, Sari E, Yuruk E, Tepeler A, Akcay M, et al. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience. Journal of endourology. 2011;25(2):327-33.

Kessaris DN, Bellman GC, Pardalidis NP, Smith AG. Management of hemorrhage after percutaneous renal surgery. The Journal of urology. 1995;153(3 Pt 1):604-8.

De Lisa A, Caddeo G. PCNL: tips and tricks in

targeting, puncture and dilation. Arch Ital Urol Androl. 2010;82(1):32-3.


Creative Commons License 
This work is licensed under a Creative Commons Attribution 3.0 License