title: Renal parenchymal damage after percutaneous nephrolithotomy with one-stage tract dilation technique: a randomized clinical trial.
abstract: OBJECTIVE
  To compare the effects of one-stage vs gradual dilation techniques during percutaneous nephrolithotomy (PCNL) on postoperative renal scar formation and overall renal function.
  
  
  METHODS
  Of 152 adult patients who underwent surgery during the study period, 48 were randomized into two groups. In group 1 (n=19), gradual tract dilation with Alken metallic dilators was used, and in group 2 (n=29), one-stage tract dilation was used. We compared patient demographics, intraoperative and preoperative parameters, postoperative overall renal function, and renal scar formation on the target renal pole.
  
  
  RESULTS
  Access time (P=0.001; 95% confidence interval [CI]: 3.19-6.30) and radiation exposure during access (P=0.03; 95% CI: 0.03-0.66) were significantly shorter in group 2. In group 1, the decrease in mean technetium-99m dimercaptosuccinic acid (99m-Tc DMSA) uptake from 44.1±20.1% to 43.4±19.6% 4 weeks postoperatively (-0.7%±0.5%; P=0.27; 95% CI: -0.56-1.93) was not significant. In group 2, however, there was a significant decrease in post-PCNL 99m-Tc DMSA uptake 2 (-2.4±0.3%, from 50.1±13.5% to 47.7±13.8%; P=0.001; 95% CI: 1.13-3.66). Four weeks after surgery, new scar formation or progression of the preoperative scar at the site of access were seen in 14 of 29 (48.3%) patients who were treated with one-stage dilation whereas only 2 of 19 (11.0%) patients who were treated with gradual dilation developed new scarring at the access site (P=0.007).
  
  
  CONCLUSIONS
  Although the one-stage tract dilation technique reduced radiation exposure and access time, in the short term, it may cause more parenchymal damage than the gradual dilation technique.
authors.affiliation: Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran. aminsharifi_ar@yahoo.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Mehrosadat
authors.initials: M
authors.lastname: Alavi
authors.forename: Ghasem
authors.initials: G
authors.lastname: Sadeghi
authors.forename: Saeed
authors.initials: S
authors.lastname: Shakeri
authors.forename: Firoozeh
authors.initials: F
authors.lastname: Afsar
mesh_terms: D000328:Adult; D002404:Catheterization / Q000379:methods*; D002921:Cicatrix / Q000473:pathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000379:methods*; D019990:Perioperative Care