Operating times and clinical outcomes in percutaneous nephrolithotomy: A comparison of tract dilation methods

Purpose: The study investigated that two different tract dilatation method affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the single-center study.

Materials and Methods: All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (January, 2013 to August, 2015) were eligible for inclusion. PCNL procedures were performed according to local clinical guidelines and practices. Nephrostomy tract dilation was performed using balloon dilation or Amplatz serial dilation. Hematologic complications assessed included bleeding rates, transfusion rates, and preoperative and postoperative hemoglobin values. Hospital stay (days) and the stone free rate are also included into outcome parameters.

Results: The median operating time with balloon dilation (n = 142) was significantly shorter than Amplatz serial dilation (n =54) at 88.0 vs 135.9 minutes, respectively (P < 0.0001). In the balloon dilation group, there was significantly less of drop in hemoglobin (1.3 vs 2.0 g/dL, respectively; P < 0.0001) and shorter hospital stay (6.93 vs 7.89 days, respectively, P = 0.047). Transfusions rate in balloon dilation group has no significantly difference compared with the Amplatz serial dilator group (15.4% vs 20.3%, respectively; P = 0.418). Univariate analysis revealed the use of balloon dilation has shorter operating time, less of drop in hemoglobin level and less hospital stay. By multivariate analysis, the use of balloon dilator reduce 43% bleeding risk although not reached statistical significance (Odds ratio [OR] 0.57; P = 0.121). Other significant predictive factors included operating time, and stone burden.

Conclusion: This study shows that in PCNL, the use of balloon dilator has shorter operating time. Factors that are associated with bleeding/transfusion include operating time and stone burden.