A Comparative Clinical Trial Study Between Hybrid Single Dilatation and Sequential Dilatation during Percutaneous Nephrolithotomy

Abstract

Background: n important and integral step in percutaneous nephrolithotomy is renal puncture and tract dilatation with insertion of the access sheath. There are currently three standard methods for renal dilatation including telescopic metal coaxial dilators (Alken dilators), semirigid polyurethane fascial dilators (Amplatz dilators), and one-step balloon dilatation. Aim: To assess the differences between the Hybrid Single Dilatation and Sequential Dilatation during Percutaneous Nephrolithotomy regarding the effectiveness and complications Methods: A comparative clinical trial study was conducted in the Department of Urology/Al-Yarmok Teaching Hospital/Iraq during the period from the 1st of January 2021 to the 1st of April 2022. A convenient sample of 100 patients with renal stones who presented with renal stones larger than 20 mm, staghorn or partial staghorn and were scheduled to have PCNL was included in the current study. The patients were submitted into two groups and were managed with hybrid single dilatation or with sequential dilatation. Results: Sequential dilatation was associated with a significantly longer duration of operation and x-ray exposure than hybrid single dilatation (P-value=0.003 and 0.001, respectively). Regarding the complications, the hybrid single dilatation was associated with a significantly lower mean of haemoglobin drop and hospital stay after the operation (Pvalue=0.001 for both). In addition, a higher proportion of patients with Clavien grading scores II and III were recorded in sequential dilatation than in hybrid single dilatation procedures Conclusion: The hybrid single dilatation was significantly associated with a shorter time of operation and a shorter time of x-ray exposure compared to sequential dilatation. In addition, it was significantly associated with fewer complications including haemoglobin drop, and postoperative hospital stay.