Does salvage endoscopically guided tract dilatation increase complications during sonography-guided percutaneous nephrolithotomy?

Abstract

Background: In percutaneous nephrolithotomy, when tract dilatation fails due to short advancement, endoscopic tract dilatation can be used as a salvage technique for renal access. We aimed to report complications of this technique and compare it with uneventful dilatation cases.

Methods and materials: The study enrolled patients who underwent sonography-guided PCNL for six consecutive months in 2023. After renal puncture under the sonography guide, an Amplatz dilator was used for one-shot tract dilation. In the case of short-advancement, a bi-prong forceps was used under direct endoscopic vision for tract dilatation. The study compared the operation time, postoperative complications, and stone-free rate between successful one-shot Amplatz dilatation (SA) and those with salvage endoscopic tract dilatation (SE).

Results: The study included 108 patients with a mean age of 47.9 ± 11.6 (50.9% male). Short-advancement occurred in 63 patients (58.3%). The salvage technique was successful in 95.2% of occasions of short advancement. Pre-operative demographic and clinical data were not different in this group compared to the (SA) group. The operative time was 21.1 ± 14.5 min in the (SE) group, which was not longer than the (SA) group with 22.7 ± 12.6 min (p = 0.2). The stone-free rate was 81.0% in the (SE) group, which was not inferior to 73% in the (SA) group (p = 0.3). The transfusion rate and complications were not different as well.

Conclusion: Salvage bi-prong forceps tract dilation in the event of short advancement after one-shot Amplatz tract dilation during percutaneous nephrolithotomy is not linked to a higher complication rate or inferior clinical outcomes compared to successful one-shot dilation.