Comparison of Efficacy and Safety of Balloon Dilation Versus Gradual Dilation in Patients with Obesity Undergoing Supine Percutaneous Nephrolithotomy

Abstract

Introduction: We aimed to compare the safety and efficacy of gradual dilatation (GD) and balloon dilatation (BD) in supine percutaneous nephrolithotomy (PNL) in patients with obesity. Methods: The study was performed on 164 patients with a body mass index (BMI) ≥30 kg/m² who underwent supine PNL in the Galdakao-modified Valdivia position. Sixty patients who underwent tract creation with BD were defined as Group 1, and 104 patients who underwent tract creation with GD were defined as Group 2. Demographic characteristics, preoperative, intraoperative, and postoperative data were compared between the two groups. Then, binary logistic regression analysis was performed to predict stone-free status and complications, and parameters predicting success and safety were investigated. Results: There was no statistically significant difference between the two groups regarding stone-free status, transfusion rate, and the Clavien-Dindo complication grades. Fluoroscopy time and operation time were significantly lower in Group 1 than in Group 2 (P < .001 and P = .002). When the factors predicting success were analyzed, multiple stones and staghorn stones were associated with lower success in multivariate analysis. Long operation times were found to be significant in predicting the development of complications in multivariate analysis. Conclusions: BD and GD have similar success and complication rates as dilatation methods in patients with obesity. BD method may provide less X-ray exposure with shorter fluoroscopy and operation time, but both methods can be used safely in supine PNL in patients with obesity.

Keywords: balloon dilation; gradual dilation; obesity; percutaneous nephrolithotomy; supine.