Online ISSN: 2515-8260

Keywords : Amplatz dilator

The Effects of One-Shot Tract Dilatation vs. Metal Telescopic Dilatation in Percutaneous Nephrolithotomy on Various Outcomes

Dr Sandeep Malik, Dr SS Malik

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 6, Pages 485-491

Background: In Percutaneous Nephrolithotomy, the track may be dilated using numerous incremental flexible Amplatz type, Alken metal telescopic dilators, or balloons (PCNL) (PCNL). The balloon dilator is the most expensive method. In both cases, the gradual dilation methods take longer and are more prone to failure. The goal of this study was to evaluate the effectiveness of metal telescopic dilatation vs a single dilatation procedure in percutaneous nephrolithotomy.
Material and methods: All adult patients undergoing PCNL surgery for renal or upper ureteric stone disease were included in the analysis. One hundred patients were used in this study, and they were randomly divided into two Categories. Category 1 patients were treated with MTD, whereas Category 2 patients underwent OSD. After the nephroscope was dilated enough, its sheath was inserted. In this case, pneumatic lithotripsy was used once the stone was located. As soon as the fragments were extracted, a standard DJ stent was placed across the ureter into the bladder. The patient was turned supine and sent to the ward when they were stabilised.
Results: Hydronephrosis, symptom duration, and history of flank surgery were all similar across the two Categorys (Table 2). Category B had somewhat bigger stones than Category A (2.80±0.77 vs. 2.50±0.71), but this difference did not reach statistical significance (0.21). Laterality and dispersion of stones were uniform throughout cultures. It was shown that the lower calyx was more often chosen for puncture in both sets of subjects. Category A required significantly more time under fluoroscopy for dilatation of the tract than Category B (54.11±3.58sec vs. 37.89±2.74 sec, p=.002) Category A also had a much longer time to access than Category B (407.58±55.87 sec vs 301.71±39.71 sec, P=0.001).  Haemoglobin dropped considerably more in Category 2 at 24 hours post-op . Both Categories had similar mean hospital stays and blood transfusion rates (p=0. 41 and p=0.55). There were five patients in Category 2 with Grade 3 issues, compared to three in Category 1.
Conclusion: When it comes to dilatation of the tract during PCNL, both OSD and MTD are effective and safe options. When it comes to tract dilatation, OSD saves time and reduces radiation exposure compared to MTD. Same length of hospital stay, decrease in haemoglobin, percentage of patients without stones, and occurrence of complications were seen with both methods.