title: One-shot dilation in modified supine position for percutaneous nephrolithotomy: experience from over 300 cases.
abstract: OBJECTIVE
  To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in modified supine position percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  A total of 320 PCNL in a total of 291 patients were performed between October 2008 and July 2011. There were no specific exclusion criteria. Patients with kidney anomalies or solitary kidney, with history of renal surgery or extracorporeal shockwave lithotripsy (SWL), those with staghorn calculi or needing more than one access, were eligible for inclusion. Data collected included patient demographics and stone characteristics, access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions.
  
  
  RESULTS
  Mean stone size was 38 mm (16-110 mm). The mean time access was 2.1 min (range 0.7-6.2 min). Tract dilatation fluoroscopy time was 25 ± 17 sec. The targeted calix could be entered with a success rate of 97.81%. The mean hemoglobin decrease was -1.17 g/dL ± 0.84. There were no visceral, pleural, collecting systems or vascular injuries. Major complications included, transfusion in 4 (1.25%) patients, pseudoaneurysm with persistent bleeding necessitating nephrectomy in 1 (0.3%) patient and two deaths (0.62%) after surgery. There was no significant difference in successful access and complications between patients with and without previous open surgery and in those with or without staghorn stones (P > .05).
  
  
  CONCLUSIONS
  The use of one shot and modified supine position combines the advantages of these both methods including less radiation exposure and shorter access and operative time. The one shot dilation is safe, easy to learn, cost effective and offers a potential alternative to the standard devices particularly in developing countries.
authors.affiliation: Department of Urology, Military Hospital Avicenna, Marrakech, Morocco. youness.elharrech@ gmail.com.
authors.forename: Youness
authors.initials: Y
authors.lastname: El Harrech
authors.affiliation: Department of Urology, Military Hospital Avicenna, Marrakech, Morocco.
authors.forename: Najib
authors.initials: N
authors.lastname: Abakka
authors.affiliation: Department of Urology, Military Hospital Avicenna, Marrakech, Morocco.
authors.forename: Jihad
authors.initials: J
authors.lastname: El Anzaoui
authors.affiliation: Department of Urology, Military Hospital Avicenna, Marrakech, Morocco.
authors.forename: Omar
authors.initials: O
authors.lastname: Goundale
authors.affiliation: Department of Urology, Military Hospital Avicenna, Marrakech, Morocco.
authors.forename: Driss
authors.initials: D
authors.lastname: Touiti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004106:Dilatation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D061646:Operative Time; D056888:Patient Positioning; D011446:Prospective Studies; D011829:Radiation Dosage; D013997:Time Factors; D055815:Young Adult
chemical_list: D006454:Hemoglobins