Perkütan Nefrolitotomi (PCNL) Esnasında Trakt Dilatasyon Teknikleri Arasındaki Farklılıklar

Year 2018, Volume: 9 Issue: 2, 97 - 102, 27.06.2018

Ercan Yuvanç , Erdal Yilmaz

https://doi.org/10.18663/tjcl.413765

Abstract

Amaç:
Ciltten böbrek taşına kadar olan mesafenin dilatasyonu Perkütan Nefrolitotomi
(PCNL) operasyonunun önemli adımlarındandır. Ancak, maliyet ve radyasyon
maruziyeti nedeniyle uygun dilatasyon metodu konusunda tartışmalar sürmektedir.
Bu amaçla, PCNL’de trakt dilatasyonu esnasında 12F Amplatz dilatatör + balon
dilatatör kullanımının dilatasyon ve skopi süresi üzerine etkisini
değerlendirmek için kontrollü klinik çalışma planlandı.

Gereç ve Yöntemler:
Böbrek taşı nedeniyle PCNL endikasyonu olan 60 hasta çalışmaya dahil edildi ve
3 gruba ayrıldılar. Grup 1’de sadece 12F Amplatz ile dilatasyon sonrası balon
dilatasyonu yapılırken, Grup 2’de öğretilerde tarif edildiği gibi sırasıyla
8/10 dilatatör/sheat set, dual-lümen üreteral katater ve Zebra^TM
açılı uçlu kılavuz tel sonrası balon dilatasyon uygulandı. Grup 3’de ise balon
dilatatör uygulanmadan 10-30F arası Amplatz dilatatörler ile trakt dilatasyonu
sağlandı. Taşa erişim süresi, dilatasyon süresi, amelitay süresi, skopi süresi,
maliyet, nefrostomi tüpünün çıkarılma süresi ve hastanede kalış süresi
parametreleri kaydedildi.

Bulgular:
Dilatasyon süresi, operasyon süresi  ve
skopi süresi Grup 1’de diğer iki grup ile karşılaştırıldığında anlamlı derecede
daha kısaydı (p<0.05). Maliyet Grup 2’de diğer gruplar ile
karşılaştırıldığında daha fazlaydı.

Sonuç:
Kısa dilatasyon süresi, kısa operasyon süresi, düşük skopi zamanı ve düşük
maliyet nedeniyle 12F Amplatz dilatör kullanılarak balon dilatasyonun yapılması
avantajlı görünmektedir.

Keywords

Böbrek taşları, Perkütan nefrolitotomi, 12F amplatz dilatator, Balon dilatasyonu

Differences between types of tract dilatation techniques during percutaneous nephrolithotomy (PCNL).

Abstract

Aim:
Dilation of the distance
from the skin to the kidney stone is one of the
important steps of percutaneous nephrolithotomy (PCNL).However, due to cost and exposure to
radiation, there is a debate about the proper dilatation method.
For this purpose, a controlled clinical trial was planned to evaluate the
effectiveness of the use of 12 F Amplatz dilator + balloon dilator in terms of
shorter duration of tract dilation and scopy time during PCNL.

Material and Methods:
60 patients with kidney stones and performed PCNL were included in the study
and divided into 3 groups. While balloon dilation was maintained after using
12F Amplatz dilator -only- in Group 1, balloon dilation was performed after
using 8/10 dilator/sheat set, dual-lumen ureteral catheter and Zebra^TM
angled type guidewire as described in the teachings in Group 2. Dilation in
patients in Group 3 was performed with just Amplatz dilators ranging from 10F
to 30F without using balloon dilation. The access time, dilation time,
operation time, scopy time, cost, nephrostomy tube removal time, hospital stay
period parameters were recorded.

Results:
Dilation, operation and scopy times were significantly lower in Group 1
compared to the two other groups (p<0.05).  The costs were higher in Group 2.                        

Conclusion:
Due to the shorter dilation, scopy and operation time and cost benefits, using
12F Amplatz dilator before and then balloon dilator seems advantageous. 

Keywords

kidney stones, Percutaneous nephrolithotomy, 12F amplatz dilator, balloon dilatation

References

• 1. Ramakumar S, Segura JW. Renal calculi. Percutaneous management. Urol Clin North Am 2000; 27: 617-22.
• 2. Casey WC, Goodwin WE. Percutaneous antegrade pyelography and hydronephrosis: direct, intrapelvic injection of urographic contrast material to secure a pyeloureterogram after percutaneous needle puncture and aspiration of hydronephrosis. J Urol 1995; 74: 164-73.
• 3. Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976; 10: 257-59.
• 4. Karakoyunlu N, Goktug G, Şener NC, Zengin K, Nalbant I, Ozturk U, Ozok U, Imamoglu A. A comparison of standard PCNL and staged retrograde FURS in pelvis stones over 2 cm in diameter: a prospective randomized study. Urolithiasis. 2015; 43: 283-90.
• 5. Kim SC, Kuo RLK, Lingeman JE. Percutaneous nephrolithotomy: an update. Curr Opin Urol 2003; 13: 235-41.
• 6. Goharderakhshan RZ, Schwartz BF, Rudnick DM, Irby PB, Stoller ML. Radially expanding single-step nephrostomy tract dilator. Urology 2001; 58: 693-96.
• 7. Davidoff R, Bellman GC. Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 1997; 157: 1229-31.
• 8. Bennet JD. Percutaneous renal access: how I do it. Can Assoc Radiol J 2001; 52: 112-17.
• 9. Türk C, Knoll T, Köhrmann KU. New guidelines for urinary stone treatment. Controversy or development? Urologe A 2008; 47: 591-93.
• 10. Allen D, O’Brien T, Tiptaft R, Glass J. Defining the learning curve for percutaneous nephrolithotomy. J Endourol 2005; 19: 279-82.
• 11. Kase KR. Radiation Protective Principles of NCRP. Health Phys 2004; 87: 251-57.
• 12. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007; 37: 1- 332.
• 13. Kumari G, Kumar P, Wadwa P, Aron M, Gupta NP, Dogra PN. Radiation exposure to the patient and operating room personel during percutaneous nephrolithotomy. Int Urol Nephrol 2006; 38: 207-10.
• 14. Kumar P. Radiation safety issues in fluoroscopy during percutaneous nephrolithotomy. Urol J 2008; 5: 15-23.
• 15. Inglis JA, Tolley A, Law J. Radiation safety during percutaneous nephrolithotomy. Br J Urol 1989; 63: 591-93.
• 16. Pfab R, Schütz W, Vogel E, Kretschko J, Kloiber W. Radiation exposure of the surgeon in percutaneous nephrolithopaxy. Urologe A 1986; 25: 216-19.
• 17. Lipkin M, Mancini JG, Toncheva G et al. Organ-specific radiation dose rates and effective dose rates during percutaneous nephrolithotomy. J Endourol 2012; 26: 439-43.
• 18. Frattini A, Barbieri A, Salsi P, Sebastio N, Ferretti S, Bergamaschi E, Cortellini P. One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 2001; 15: 919-23.
• 19. Amjadi M, Zolfaghari A, Elahian A, Tavoosi A. Percutaneous nephrolithotomy in patients with previous open nephrolithotomy: one-shot versus telescopic technique for tract dilatation. J Endourol 2008; 22: 423-25.
• 20. Wezel F, Mamoulakis C, Rioja J, Michel MS, de la Rosette J, Alken P. Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 2009; 23: 1655-61.
• 21. Gonen M, Istanbulluoglu OM, Cicek T, Ozturk B, Ozkardes H. Balloon dilatation versus Amplatz dilatation for nephrostomy tract dilatation. J Endourol 2008; 22: 901-04.
• 22. Kalpee AR, Venter R, Fourie T. Single-centre comparison of a novel single- step balloon inflation device and Amplatz sheath dilatation during percutaneous nephrolithotomy: a pilot study. Urology 2012; 50: 79-81.
• 23. Kukreja R, Desai M, Patel S, Bapat S, Desai M. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 2004; 18: 715-22.