Effect of Different Years of Resident Training on Complications and Stone Free Rate during Percutaneous Nephrolithotomy for Large Renal Stone Greater Than 20 mm: A Prospective Observational Study Using Balloon Dilator

Pao-Hwa Chen, Meng-Yi Yan, Heng-Chieh Chiang, Bai-Fu Wang, Jesun Lin, Chin-PaoChang, Sheng-Hsien Huang, Chun-Chi Chen, Hung-Jen Shih, Chien-Hsiang Chang, Jian-Ting Chen and Yao-Li Chen

Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
Changhua Christian Hospital, Changhua, Taiwan
School of Medicine, Chung Shan Medical University, Taichung, Taiwan
School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

^*Correspondance to: Heng-Chieh Chiang 

 PDF  Full Text DOI: 10.25107/2474-1647.2098

Abstract

Objective: The endoscopic management of urolithiasis has been the primary choice of treatment for upper urinary tract urolithiasis. For large symptomatic renal calculi, Percutaneous Nephrolithotomy (PCNL) provides the highest stone clearance rate. In this prospective study, we compared patients undergoing PCNL using balloon dilator with sequential Amplatz dilator.Methods: We started using balloon dilator for nephrostomy tract for PCNL since August 2014. From August 2014 to July 2015, we performed 154 C-arm guided PCNL procedures with balloon dilator at our hospital. We prospectively followed these patients and recorded peri - and post-operative data and complications. We then compared the same data with 155 patients using Amplatz dilator in the previous year.Results: A total of 309 patients were included in this study (154 patients in balloon and 155 in the Amplatz dilator). The average stone burden was larger in the Amplatz group (1189 vs. 771 mm2). Balloon dilator group has a slightly better stone free rate (78% vs. 75%). Patients with residual stone are the ones with higher stone burden on KUB (1734 and 1512 mm2). Surgeon's experience is also a factor in stone free rate. Most of the complication is Clavien grade 1-2. There were 3 patients Clavien grade 3 or higher in both group and no mortality.Conclusion: Balloon dilator is non-inferior to sequential dilator in terms of complications. Surgeon’s experience seems to influence stone-free rate and blood loss. Future randomized trials are needed to establish the benefit of balloon dilator.

Keywords

Nephrolithotomy; PCNL; Percutaneous; Stone; Urolithiasis

Cite the article

Chen P-H, Yan M-Y, Chiang H-C, Wang B-F, Lin J, Chang C-P, et al. Effect of Different Years of Resident Training on Complications and Stone Free Rate during Percutaneous Nephrolithotomy for Large Renal Stone Greater Than 20 mm: A Prospective Observational Study Using Balloon Dilator. Clin Surg. 2018; 3: 2098.