Investig Clin Urol.  2021 Mar;62(2):186-194. 10.4111/icu.20200276.

Efficacy and safety of modified tract dilation technique using simultaneous pulling of proximal and distal ends of a guidewire for percutaneous nephrolithotomy in modified supine position

Affiliations
  • 1Department of Urology, Kyungpook National University Chilgok Hospital, Daegu, Korea.
  • 2Department of Urology, Pohang Semyeong Christianity Hospital, Pohang, Korea
  • 3Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.
  • 4Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea.
  • 5BioMedical Research Institute, Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, Korea.
  • 6Department of Urology, Kyungpook National University Hospital, Daegu, Korea.

Abstract

Purpose
Recently, the needs for supine percutaneous nephrolithotomy (PCNL) have become more increased because of an easy approach for endoscopic combined intrarenal surgery. However, making a nephrostomy tract during supine PCNL is more difficult than prone position due to movable kidney. To overcome this limitation, we used a modified nephrostomy tract dilation (MTD) technique using guidewire traction.
Materials and Methods
From January 2014 to June 2019, a total of 259 patients underwent PCNL in the modified supine position. Among them, the MTD technique was performed in 171 patients. For the MTD technique, two hydrophilic guidewires were passed from the nephrostomy tract and brought out through the urethra, then both proximal and distal ends were contralaterally pulled with tension for the easy placement of a fascia-cutting needle and a balloon catheter. We analyzed the efficacy of this technique in comparison with the conventional method.
Results
Intraoperative radiation exposure time (RET) (68.87 vs. 212.11 s) and hospital stay (5.90 vs. 6.74 days) were significantly shorter, while the success rate (77.2% vs. 63.6%) was significantly higher in the MTD group. Multivariate analysis showed that only the maximal stone diameter (odds ratio [OR], 1.928; 95% confidence interval [CI], 1.314–2.828; p=0.001) and MTD technique (OR, 0.017; 95% CI, 0.007–0.040; p<0.001) were independent factors for predicting short RET (<120 s).
Conclusions
This study demonstrated that MTD technique can be effectively and safely performed in modified supine position PCNL, and it can be helpful in reducing RET and enhancing success rates.

Keyword

Kidney calculi; Nephrolithotomy; percutaneous; Nephrostomy
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