versión On-line ISSN 2078-5151
versión impresa ISSN 0038-2361
S. Afr. j. surg. vol.50 no.3 Cape Town ago. 2012
A R KalpeeI; R VenterII; T FourieIII
IMB ChB; Department of Urology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
IIMB ChB, FCUrol (SA); Department of Urology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
IIIMB ChB, MMed (Urol); Department of Urology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
OBJECTIVE: A new second-generation balloon dilatation device for percutaneous nephrolithotomy (PCNL) has been launched, promising to challenge the traditional Amplatz serial dilators (ASDs). This device allows for the polyurethane sheath to be deployed on balloon inflation. Our primary objective in this pilot study was to determine whether the use of this new device impacted on overall patient outcome when compared with the traditional ASD system.
DESIGN: Retrospective chart review.
SETTING: Department of Urology, Inkosi Albert Luthuli Central Hospital, Durban.
SUBJECT: Single-centre comparison of a novel single-step balloon inflation device and Amplatz sheath dilatation during percutaneous nephrolithotomy - a pilot study.
OUTCOME MEASURES: Single procedure success rates, retreatment rates, hospital stay, haemoglobin concentration, calculi volume, calculi configuration, patient demographics.
RESULTS: The stone-free rates after a single procedure were 30% (3/10) in the Amplatz sheath dilatation arm (series 1) and 80% (8/10) in the single-step balloon inflation device arm (series 2). Correspondingly, 11 individual repeat procedures in 7 patients (4 relook PCNLs, 5 ureteroscopies and 2 extracorporeal shockwave lithotripsies) were required in series 1 to render the remaining 70% stone free. Mean hospital stay was 5.2 days (range 3 - 10 days) in series 1 and 3.8 days in series 2. The mean fall in haemoglobin concentration after treatment was 1.79 g/dl in the whole group, 2.1 g/dl in series 1, and 1.5 g/dl in series 2.
CONCLUSION: The single-step balloon dilatation device is found to have an improved patient outcome compared with ASDs.
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2. Lopes T, Sangam K, Alken P, et al. The Clinical Research Office of the Endourological Society. Percutaneous Nephrolithotomy Global Study: Tract dilation comparisons in 5537 patients. J Endourol 2011;25(5):755-762. [ Links ]
3. Lingeman J, Newmark J, Wong M. Classification and management of staghorn calculi. In: Smith AD, ed. Controversies in Endourology. Philadelphia: Saunders, 1995:136-144. [ Links ]
4. Preminger GM, Assimos DG, Lingeman JE, et al. Diagnosis and treatment recommendations. AUA guideline on management of staghorn calculi: chapter 1. J Urol 2005;173:1991-2000. [ Links ]
5. Baldwin D, Maynes LJ, Desai PJ, et al. A novel single step percutaneous access sheath: The initial experience. J Urol 2006;175:156-161. [ Links ]
6. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 1997;157:1229-1231. [ Links ]
7. Falahatkar S, Neiroomand H, Akbarpour M, et al. One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: Comparison of safety and efficacy. J Endourol 2009;23:615-618. [ Links ]
8. Safak M, Gogu C, Soygu T. Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: Experience with 95 cases and comparison with the fascial dilator system. Urol Int 2003;71:382-384. [ Links ]
9. Frattini A, Barbieri A, Salsi P, et al. One shot: A novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 2001;15:919-923. [ Links ]
10. Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906. [ Links ]
11. Segura JW, Patterson DE, LeRoy AJ, et al. Percutaneous removal of kidney stones: Review of 1,000 cases. J Urol 1985;134:1077-1081. [ Links ]
12. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. JAMA 1955;157:891-894. [ Links ]
13. Stables DP, Holt SA, Sheridan HM, et al. Permanent nephrostomy via percutaneous puncture. J Urol 1975;114:684-687. [ Links ]
14. Wezel F, Mamoulakis C, Rioja J, et al. Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 2009;23:1655-1661. [ Links ]