title: Metal telescopic and Amplatz sheath dilation in nephrolithotomy.
abstract: BACKGROUND
  Comparison of Amplatz sheath percutaneous nephrolithotomy (Amplatz PCNL) and metal telescopic dilation PCNL (MTD PCNL) with respect to clinical outcomes and complications.
  
  
  METHODS
  Single-institution retrospective chart review with 73 patients who underwent PCNL divided into two groups: Amplatz PCNL (n = 26) and MTD PCNL (n = 47). Efficacy (stone-free rate, residual stones, and surgical duration) and safety (transfusion rate and hemoglobin decrease) were evaluated. Complications were recorded and classified using the modified Clavien classification system.
  
  
  RESULTS
  The two PCNL groups were similar regarding mean age, stone burden, side, stone location, and stone composition. There were no significant differences in surgery duration (101 ± 28 vs. 98 ± 30 min; P = 0.906), transfusion rate (3.9% vs. 4.3%; P = 0.382), and hemoglobin drop (0.9 ± 0.9 vs. 1 ± 0.7 g/dl; P = 0.424) for Amplatz and MTD PCNL, respectively. Stone-free rate (86% vs. 68%; P = 0.001) was significantly higher while residual fragments rate (37% vs. 60%; P = 0.001) was significantly lower in Amplatz PCNL compared to MTD PCNL. However, tube stay time (4.4 ± 1.8 vs. 5.8 ± 3.6 days; P = 0.005) and hospital time (8.6 ± 2.6 vs. 9.7 ± 5.5 days; P = 0.0001) were significantly longer in Amplatz PCNL compared to MTD PCNL. Clavien grading revealed a significantly higher rate of low-grade complications (I-III) for the MTD PCNL in comparison to Amplatz PCNL (10.6% vs. 3.9%, respectively; P = 0.011). There were no major complications and no tract dilation failure.
  
  
  CONCLUSIONS
  The study demonstrates that Amplatz PCNL is a safe and effective procedure to remove large renal stones compared with MTD PCNL.
authors.affiliation: Department of Urology, University Medical Center Goettingen, Göttingen, Germany.
authors.forename: Sameh
authors.initials: S
authors.lastname: Hijazi
authors.affiliation: Department of Urology, Staetische Kliniken Moenchengladbach, Mönchengladbach, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Echtle
authors.affiliation: Department of Urology, University Medical Center Goettingen, Göttingen, Germany.
authors.forename: Viktoria M
authors.initials: VM
authors.lastname: Hasselhof
authors.affiliation: Department of Urology, University Medical Center Goettingen, Göttingen, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Trojan
authors.affiliation: Department of Urology, University Medical Center Goettingen, Göttingen, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Heinrich
keywords: Amplatz sheath; metal telescopic dilation; percutaneous nephrolithotomy; renal stones
references.citation: J Urol. 1985 Dec;134(6):1077-81
references.pmid: 4057395
references.citation: J Urol. 1994 Dec;152(6 Pt 1):1977-81
references.pmid: 7966654
references.citation: Can J Urol. 2013 Dec;20(6):7050-9
references.pmid: 24331348
references.citation: J Endourol. 2011 Feb;25(2):327-33
references.pmid: 21214412
references.citation: J Endourol. 2008 Apr;22(4):637-40
references.pmid: 18338958
references.citation: Urology. 2011 Feb;77(2):299-304
references.pmid: 20970842
references.citation: Eur Urol. 2005 Jan;47(1):22-8
references.pmid: 15582245
references.citation: J Urol. 2007 May;177(5):1867-71
references.pmid: 17437838
references.citation: J Endourol. 2011 Jun;25(6):933-9
references.pmid: 21568697
references.citation: Eur Urol. 2005 Nov;48(5):832-7
references.pmid: 16203078
references.citation: Urol Clin North Am. 1997 Feb;24(1):43-58
references.pmid: 9048851
references.citation: J Urol. 2001 Dec;166(6):2072-80
references.pmid: 11696709
references.citation: BJU Int. 2005 Oct;96(6):875-8
references.pmid: 16153221
references.citation: J Endourol. 2012 Jun;26(6):630-4
references.pmid: 21999400