Comparative Study between One-Shot Dilatation versus Serial Dilatation Techniques for Access in Percutaneous Nephrolithotomy in Adult Patients

Abstract Background With the development of minimally invasive treatment of urinary calculi, percutaneous nephrolithotomy (PCNL) has become one of the main treatments for large kidney and upper ureteral stones. Aim and Objectives This comparative study aimed to compare and assess the safety, efficacy, outcome, and feasibility, intraoperative and postoperative complications of one-shot dilatation versus serial dilatation techniques for access during percutaneous nephrolithotomy for management of renal stone disease in adult patients. Subjects and Methods This Prospective randomized controlled clinical trial was conducted in Dar Alshifa hospital and Ain Shams University hospitals in Cairo. This study was carried out on 60 patients who underwent percutaneous nephrolithotomy for renal stone disease. Patients were randomized by computer generated tables into 3 groups, 20 patients for each group; (Group A) renal dilatation would be done by one-shot dilatation technique using 30Fr Amplatz dilator directly over the central Alken rod, (Group B) as a control group, using metallic telescopic dilators (Alken), and (Group C) using sequential fascial dilators (Amplatz). Results Mean access time and fluoroscopy time for dilation among the study groups. Mean access time in Group A ranged from 3 to 6 with mean ± SD = 4.65 ± 0.6, while in Group B the Mean access time ranged from 5 to 9 with mean ± SD = 7.15 ± 0.93, while in Group C the Mean access time ranged from 5 to 9 with mean ± SD = 6.94 ± 0.9, with highly statistical significant difference between the three groups. Mean fluoroscopy time for dilation (sec) in Group A ranged from 31 to 44 with mean ± SD = 36.95 ± 4.08, while in Group B the Mean fluoroscopy time for dilation (sec) ranged from 41 to 79 with mean ± SD = 62.15 ± 8.18, while in Group C the Mean fluoroscopy time for dilation (sec) ranged from 61 to 73 with mean ± SD = 67.05 ± 3.43, with highly statistical significant difference (p = <.001) between the three groups. Regarding Failure of access, there was no statistical significant difference between the three studied groups (p = 0.362). Regarding Perforation, all groups had no incidence of perforation. Transfusion rate in Group A ranged from 3 to 4 with mean ± SD = 3.25 ± 0.44, while in Group B the Transfusion rate ranged from 3 to 5 with mean ± SD = 4.1 ± 0.55, while in Group C the Transfusion rate ranged from 3 to 5 with mean ± SD = 4.2 ± 0.52, with highly statistical significant difference (p = <0.001) between the three groups. Stone free in Group A ranged from 66 to 97 with mean ± SD = 84.1 ± 9.14, while in Group B the Stone free ranged from 66 to 95 with mean ± SD = 83.65 ± 8.92, while in Group C the Stone free ranged from 68 to 92 with mean ± SD = 80.7 ± 6.71, with no statistical significant difference (p = 0.38) between the three groups. Complications (%) in Group A ranged from 3 to 7 with mean ± SD = 5 ± 0.9, while in Group B the Complications (%) ranged from 3 to 7 with mean ± SD = 4.85 ± 0.87, while in Group C the Complications (%) ranged from 3 to 7 with mean ± SD = 5.15 ± 0.93, with no statistical significant difference (p = 0.067) between the three groups. Time to nephrostomy removal in Group A ranged from 1 to 2 with mean ± SD = 1.35 ± 0.49, while in Group B the Time to nephrostomy removal ranged from 1 to 2 with mean ± SD = 1.85 ± 0.37, while in Group C the Time to nephrostomy removal ranged from 1 to 2 with mean ± SD = 1.9 ± 0.31, with highly statistical significant difference (p = <.001) between the three groups. Hospital days in Group A ranged from 2 to 3 with mean ± SD = 2.65 ± 0.49, while in Group B the Hospital days ranged from 3 to 4 with mean ± SD = 3.15 ± 0.37, while in Group C the Hospital days ranged from 3 to 4 with mean ± SD = 3.5 ± 0.51, with highly statistical significant difference (p = <.001) between the three groups. Conclusion One-shot dilation technique is as effective, safe and feasible as telescopic metal dilatation. In addition, it has a significant reduction in access tract dilation time and exposure radiation time with lesser chance of blood transfusion.