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Comparative Study
. 2023 Jun;41(6):1659-1666.
doi: 10.1007/s00345-023-04393-0. Epub 2023 Apr 11.

Comparison of safety and efficacy of one shot dilation vs. gradual dilation technique in supine percutaneous nephrolithotomy

Mert Hamza Özbilen  1 , Batuhan Ergani  2 , Taha Çetin  3 , Mehmet Yiğit Yalçın  4 , Çağdaş Bildirici  5 , Erkin Karaca  5 , Mehmet Çağlar Çakıcı  6 , Tufan Süelözgen  5 , Gökhan Koç  5 , Yusuf Özlem İlbey  7
Affiliations
Comparative Study

Comparison of safety and efficacy of one shot dilation vs. gradual dilation technique in supine percutaneous nephrolithotomy

Mert Hamza Özbilen et al. World J Urol. 2023 Jun.

Abstract

Purpose: To compare the efficacy and safety of gradual dilation (GD) and one-shot dilation (OSD) techniques in patients who underwent supine percutaneous nephrolithotomy (PCNL).

Methods: The data of 176 patients who underwent supine PCNL were reviewed. Eighty-seven patients who underwent OSD were defined as group 1, and 89 patients who underwent GD were defined as group 2. Both surgical techniques were compared with each other in terms of various parameters. Then, regression analysis of factors predicting stone-free status and complications in patients who underwent supine PNL were performed. Then, regression analysis of factors predicting success rate and complications in patients who underwent supine PNL were performed.

Results: No statistical difference was found in terms of stone-free rate, Clavien-Dindo complication grade and operation time. No statistical difference was found in terms of success rate, Clavien-Dindo complication grade and operation time. However, the fluoroscopy time was found to be significantly shorter in group 1 (p < 0.001). In the analysis of factors predicting stone-free status, the presence of calyceal stones, increased stone size and number were associated with a decrease in stone-free rate. In the analysis of factors predicting success, the presence of calyceal stones, increased stone size and number were associated with a decrease in success rate. Increased fluoroscopy and operation time, increased complication rates were found to be significantly associated with residual stone. Analysis of factors predicting complications found a higher complication rate in patients with low BMI and severe hydronephrosis. Increased complication was associated with increased time to nephrostomy removal and hospital stay, decrease in stone-free rate, decrease in Hb and increase in Cre value at the postoperative 24th hour.

Conclusion: When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar stone-free and complication rates. When comparing OSD and GD in patients undergoing supine PCNL, both techniques have similar success and complication rates. Compared to GD, the OSD technique can be preferred primarily due to its shorter fluoroscopy time.

Keywords: Gradual dilation; One-shot dilation; Percutaneous nephrolithotomy; Supine percutaneous nephrolithotomy.

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