A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy
Purpose: To evaluate the safety and the efficacy of a radiation-free 2-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy (PCNL).
Materials and Methods: From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator.
Results: The median age was 62.0 [IQR 11.0] years, and 11 (61.1%) were male. The median stone size was 3.3 [3.6] cm2, and stone laterality was almost equal over both sides. Successful tract establishment on the first attempt without fluoroscopy was achieved in 18 (94.7%) operations. The median tract establishment time was 10.4 [4.9] mins, and the median operation time was 67.0 [52.2] mins. The median hemoglobin drop was 1.0 [1.1] g/dL, and none required blood transfusion. Three (15.8%) developed fever. Pleural injury occurred in two (10.5%) operations (both had supracostal puncture), and one required drainage with pigtail. Stone-free status was achieved in 15 (77.8%) operations at 3 months postoperatively.
Conclusions: Herein we present a radiation-free 2-step tract dilation technique, which is characterized by ureteroscopic check of the partially dilated tract in between the first dilation with serial fascial dilators and the second dilation with balloon. Our data suggest that it is a safe and effective method.
- Percutaneous Nephrolithotomy
- Fascial Dilator
- Balloon Dilator
How to Cite
Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10:257-9.
Andonian S, Scoffone CM, Louie MK, et al. Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol. 2013;27:24-8.
Corrales M, Doizi S, Barghouthy Y, Kamkoum H, Somani B, Traxer O. Ultrasound or Fluoroscopy for Percutaneous Nephrolithotomy Access, Is There Really a Difference? A Review of Literature. J Endourol. 2021;35:241-8.
Lojanapiwat B. The ideal puncture approach for PCNL: Fluoroscopy, ultrasound or endoscopy? Indian J Urol. 2013;29:208-13.
Zhou T, Chen G, Gao X, et al. 'X-ray'-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy. Urolithiasis. 2015;43:189-95.
Usawachintachit M, Masic S, Chang HC, Allen IE, Chi T. Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients. Urology. 2016;98:32-8.
Ng FC, Yam WL, Lim TYB, Teo JK, Ng KK, Lim SK. Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations. Investig Clin Urol. 2017;58:346-52.
Basiri A, Ziaee AM, Kianian HR, Mehrabi S, Karami H, Moghaddam SM. Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a randomized clinical trial. J Endourol. 2008;22:281-4.
Ding X, Hao Y, Jia Y, Hou Y, Wang C, Wang Y. 3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy. World J Urol. 2020;38:2295-300.
Tzou DT, Metzler IS, Usawachintachit M, Stoller ML, Chi T. Ultrasound-guided Access and Dilation for Percutaneous Nephrolithotomy in the Supine Position: A Step-by-Step Approach. Urology. 2019;133:245-6.
Wang S, Zhang Y, Zhang X, et al. Tract dilation monitored by ultrasound in percutaneous nephrolithotomy: feasible and safe. World J Urol. 2020;38:1569-76.
Beiko D, Razvi H, Bhojani N, et al. Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it. Can Urol Assoc J. 2020;14:E104-E10.
Xiong L, Huang X, Ye X, et al. Microultrasonic Probe Combined with Ultrasound-Guided Minipercutaneous Nephrolithotomy in the Treatment of Upper Ureteral and Renal Stones: A Consecutive Cohort Study. J Endourol. 2020;34:429-33.
Zhu W, Li J, Yuan J, et al. A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy. BJU Int. 2017;119:612-8.
Pakmanesh H, Daneshpajooh A, Mirzaei M, et al. Amplatz versus Balloon for Tract Dilation in Ultrasonographically Guided Percutaneous Nephrolithotomy: A Randomized Clinical Trial. Biomed Res Int. 2019;2019:3428123.
Jin W, Song Y, Fei X. The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous Nephrolithotomy. BMC Urol. 2020;20:82.
Armas-Phan M, Tzou DT, Bayne DB, Wiener SV, Stoller ML, Chi T. Ultrasound guidance can be used safely for renal tract dilatation during percutaneous nephrolithotomy. BJU Int. 2020;125:284-91.
Karami H, Rezaei A, Mohammadhosseini M, Javanmard B, Mazloomfard M, Lotfi B. Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithotomy in the prone position: a comparative study. J Endourol. 2010;24:1357-61.
Hosseini MM, Hassanpour A, Farzan R, Yousefi A, Afrasiabi MA. Ultrasonography-guided percutaneous nephrolithotomy. J Endourol. 2009;23:603-7.
Yan S, Xiang F, Yongsheng S. Percutaneous nephrolithotomy guided solely by ultrasonography: a 5-year study of >700 cases. BJU Int. 2013;112:965-71.
Basiri A, Nouralizadeh A, Kashi AH, et al. X-Ray Free Minimally Invasive Surgery for Urolithiasis in Pregnancy. Urol J. 2016;13:2496-501.
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