A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy.
OBJECTIVE
To compare the one-shot dilation (OSD) technique with three other dilation techniques namely telescopic Alken, fascial Amplatz and balloon dilation (BD) in terms of safety efficacy and cost effectiveness.


METHODS
During a 3½ year enrollment period, 480 patients who required PCNL surgery were equally randomized into four groups. All the cases were assessed preoperatively, intraoperatively as well as postoperatively till a period of 3 months. Access time, X-ray exposure time, hemoglobin drop, complications, success rate, etc., were all assessed and recorded.


RESULTS
Similar preoperative characteristics were observed in all the four study arms. X-ray exposure time during dilation was significantly reduced for both OSD and BD when compared to sequential Amplatz and telescopic Alken dilation (Group ALD = 62.1 + 13, Group AMD = 67.0 + 10, Group OSD = 36.8 + 7, Group BD = 38.1 + 6, p value = 0.01, post hoc: G4 = G3 < G2 = G1). There was no significant difference between the access time, hemoglobin drop, complication and success rates among the groups. BD was the most expensive dilation method when compared to the other three dilation techniques.


CONCLUSIONS
All the four methods of dilation are equally safe and effective but both OSD and BD are advantageous in terms of lesser fluoroscopy time during dilation. OSD is much cheaper option when compared to BD, and therefore with more experience, it can become the preferable dilation method, especially in the developing countries.
Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India. dralokpriyanka@gmail.com.
Alok
A
Srivastava
Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India.
Sanjeet
S
Singh
Department of Urology and Renal Transplant, Dr.RMLIMS, Vibhuti Khand, Gomti Nagar, Lucknow, 226010, India.
Ishwar Ram
IR
Dhayal
Department of Surgery, B.R.D. Medical College, Gorakhpur, India.
Priyanka
P
Rai
D000328:Adult; D016063:Blood Loss, Surgical; D004106:Dilatation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007682:Kidney Pelvis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D061646:Operative Time; D011446:Prospective Studies; D014514:Ureteral Calculi / Q000601:surgery*
D006454:Hemoglobins
Cost effective; Fluoroscopy time; One-shot dilation