Amplatz Dilators Research Articles

Ultrasound-guided renal puncture followed by endoscopically guided tract dilatation vs standard fluoroscopy-guided percutaneous nephrolithotomy for non-opaque renal stones; a randomized clinical trial.

This study was designed to evaluate the non-inferiority of ultrasound puncture followed by endoscopically guided tract dilatation compared to the standard fluoroscopy-guided PCNL. Forty patients with non-opaque kidney stones eligible for PCNL were randomly divided into two groups. The standard fluoroscopy-guided PCNL using the Amplatz dilator was performed in the XRAY group. In the SONO group, the Kidney was punctured under an ultrasound guide followed by tract dilatation using a combination of the Amplatz dilator based on the tract length and an endoscopically guided tract dilatation using a bi-prong forceps in cases of short-advancement. The primary outcome was successful access. In 90% of cases in the XRAY and 95% in the SONO group access dilatation process was performed uneventfully at the first attempt (p = 0.5). In 45% of cases in the SONO group, bi-prong forceps were used as salvage for short-advancement. In one case in the X-ray group over-advancement occurred. One month after surgery, the stone-free rate on the CT-scan was 75% for the X-ray group and 85% for the SONO group (p = 0.4). There were no significant differences in operation time, hospitalization duration, transfusion, or complication rates between the two groups. We conclude that ultrasound-guided renal puncture, followed by endoscopically guided tract dilatation can achieve a high success rate similar to X-ray-guided PCNL while avoiding the harmful effects of radiation exposure and the risk of over-advancement.

(048) Synchronous Management of Urethral Stricture Disease and Penile Prosthesis Implantation: A Case Series

Abstract Introduction Urethral stricture disease (USD) is found in approximately 0.9% of all men in developed countries; however, the prevalence of USD is expected to increase with time due to an aging population, a rising incidence of prostate cancer, the use of radiotherapy, and increasing utilization of endoscopic procedures in urology. Due to an increasing prevalence of USD, surgeons may encounter an undiagnosed urethral stricture at increasing rates during penile prosthesis (PP) implantation, and there is currently limited data to evaluate the risk of treating the stricture at that time. Objective Our study aims to monitor the outcomes of PP placement in the event of a urethral stricture. Methods A retrospective IRB-approved review (IRB00205900) was performed using the Johns Hopkins EMR for patients that had undergone PP implantation and incidentally found USD at the time of procedure from 2009 to 2023. Patients undergoing PP implantation without incidentally finding USD were excluded. Cases that could proceed as planned were classified as “completed,” while cases that could not proceed were classified as “aborted.” Stricture characteristics (location, size), procedural information, pertinent demographic data, and comorbidities were noted. Successful management was defined as the absence of complications requiring explantation, including device infection, erosion, or failure, within 90 days of the procedure. Recurrence of stricture was defined as the presence or worsening of obstructive lower urinary symptoms at any post-operative follow-up visits. Results Of the 2375 PP implantations performed from 2009 to 2023, twenty-four cases were identified in which an incidental USD was found. Out of the twenty-four patients, eighteen patients (75%) had IPPs implanted, while six patients (25%) had their procedures aborted. Of the eighteen patients, thirteen (13/18, 72.2%) underwent urethral dilation with Amplatz dilators, three patients (3/18, 16.7%) had passive dilation with a 16 F flexible cystoscope, and two patients (2/18, 11.1%) received a direct vision internal urethrotomy (DVIU). Within 90 days after the procedure, only one patient presented with urinary retention four days after the procedure (1/18, 5.6%). No PP infections were reported within 90 days in any patient. Only one patient (1/18, 5.6%) had their device explanted due to extrusion five years after the procedure. One patient had a recurrence of their stricture after four years (1/18, 5.6%). Of the six patients that had their procedures aborted, three patients (3/6, 50.0%) underwent urethroplasty. One patient (1/6, 16.7%) underwent urethral dilation and suprapubic tube placement, and two patients (2/6, 33.3%) underwent a DVIU. Five of these six cases had strictures greater than 2 cm with urethral lumens between 8-10F (5/6, 83.3%), while one patient had an obliterated urethra (1/6, 16.7%). Conclusions This retrospective case study of patients receiving synchronous USD management and PP implantation yielded high success and low complication rates. While a large, multi-institutional study should be performed, our study displays promising results and creates a framework that other surgeons may follow. Disclosure No.

What is the safe and effective dilator number during access in PCNL? Three-shot dilation versus classical sequential Amplatz dilation

BackgroundAlthough PCNL has been used for a long time to treat nephrolithiasis, there is still contradictory information concerning the use of the dilation method. In this study, we aimed to compare conventional sequential Amplatz dilatation (SAD) using ten dilators and a method using three dilators (12, 20, and 30 Fr), which we named “three-shot dilatation” (3SD), in terms of fluoroscopy time (FT), operation time, bleeding and stone-free rates.MethodsThe study included patients who underwent PCNL with the SAD and 3SD methods. A different surgeon with extensive endourology experience applied each technique. One of the surgeons operated on the patients using the SAD method with ten dilators, and the other surgeon performed the operations using the 3SD method involving three Amplatz dilators (12, 20, and 30 Fr).ResultsA total of 283 patients, 138 in the 3SD group and 145 in the SAD group, were included in the study. The mean age of the patients was 47.32 ± 13.71 years. There was no statistically significant difference between the two groups regarding preoperative characteristics (p > 0.05). The FTs of access 2, total access, and total operation were significantly shorter in the 3SD group (p = 0.0001). The decrease in hemoglobin was statistically significant in the 3SD group compared to the SAD group (p = 0.022), while the blood transfusion requirements of the groups were similar (p = 0.176). There was no statistically significant difference between the two groups regarding stone-free rates (p = 0.973). In four patients in the SAD group, re-access was necessary due to the loss of passage due to the guide wire slipping out of its place.ConclusionIntraoperative FT can be shortened using the described 3SD method without compromising surgical safety. However, this method can be used as an intermediate step in the transition to one-shot dilation by surgeons experienced in performing SAD.

OUTCOMES OF URETHRAL DILATION WITH AMPLATZ DILATORS IN THE MANAGEMENT OF URETHRAL STRICTURES

This study aimed to determine the outcomes of urethral dilation with amplatz dilators in managing urethral strictures. We conducted this descriptive case series at multiple centers, including Waseem Medical Centre Batkhaila and Mercy Teaching Hospital Peshawar, from November 2022 to April 2023. A total of 30 male patients presented with urethral strictures were treated with urethral dilation using amplatz dilators. The outcomes assessed were maximum urinary flow and Post-void residual urine. Paired samples T-test was used for numerical variables. Mean age of patients was 64.87±11.96 years. Preoperative mean uroflowmetry flow (Qmax) was 8.6±2.97 mL/sec, while the PVR preoperatively was 198.4±59.19 mL. Qmax improved in 1st month at 18.87±2.64 mL/sec, in the 6th month at 17.50±2.99 mL/sec, and in the 12th month at 15.37±2.17 mL/sec (P = 0.0001). PVR improved in 1st month at 50.13±23.56 ml, 6th month at 64.47±23.31, and 12th month at 69.17±25.53 ml compared to the preoperative PVR (P = 0.0001). Urethral dilatation using amplatz renal dilators represents a technique that mitigates the inherent risks associated with blind dilatation methods. This approach is characterized by its safety, ease of application, high patient tolerance, and cost-effectiveness, rendering it a favorable alternative for treating urethral strictures.

The effect of percutaneous tract dilation technique on renal parenchymal trauma: An experimental in vivo study on a porcine model.

The purpose of this study was to evaluate renal parenchymal trauma of two-step dilation compared to the conventional Amplatz gradual dilation during percutaneous nephrolithotomy on a porcine model. A nonpapillary percutaneous access tract was established under fluoroscopic guidance in both kidneys of four female pigs. On the right kidney of each pig, gradual dilation was performed using an Amplatz dilator set with a gradual dilation to 30 Fr, whereas on the left, a two-step dilation was utilized using only 16 Fr and 30 Fr dilators. Two of the animals were euthanized immediately after the procedure and the remaining two 1 month later. The pigs that were kept alive underwent a contrast-enhanced computed tomography immediately, 15, and 30 days postoperatively. A dimercaptosuccinic acid (DMSA) scintigraphy and single-photon emission computed tomography-computed tomography (CT) were also performed after the last CT and afterward, the pigs were sacrificed. All kidneys were harvested for pathohistological examination. The follow-up radiologic imaging showed similar parenchymal damage caused by the compared dilation techniques and an expected reduction in scar size in the later scans. No scar was identified by DMSA in any kidney. Gross and microscopic examinations conducted both on the kidneys that were harvested immediately after the procedure and the ones from the animals that were left to heal, revealed no significant differences in tissue damage, grade of fibrosis, or inflammation depending on the dilation method. Our study showed no inferior outcomes caused by two-step dilation compared to gradual dilation regarding renal parenchymal damage following a nonpapillary puncture. In fact, postoperative imaging findings suggested a trend toward better healing and less scar tissue when the two-step method was used.

A Safe and Effective Two-Step Tract Dilation Technique in Totally Ultrasound-Guided Percutaneous Nephrolithotomy.

To evaluate the safety and the efficacy of a radiation-free 2-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy (PCNL). From Oct 2018 to Mar 2020, we prospectively and consecutively enrolled 18 patients with 19 kidney units with urolithiasis. The nephrostomy tract was established by the following four steps: 1) ultrasound-guided renal puncture, 2) first-stage serial dilation to 16 Fr with Amplatz dilators, 3) check and adjustment of the partially dilated tract with a ureteroscope, 4) second-stage dilation with a 24-Fr balloon dilator. The median age was 62.0 [IQR 11.0] years, and 11 (61.1%) were male. The median stone size was 3.3 [3.6] cm2, and stone laterality was almost equal over both sides. Successful tract establishment on the first attempt without fluoroscopy was achieved in 18 (94.7%) operations. The median tract establishment time was 10.4 [4.9] mins, and the median operation time was 67.0 [52.2] mins. The median hemoglobin drop was 1.0 [1.1] g/dL, and none required blood transfusion. Three (15.8%) developed fever. Pleural injury occurred in two (10.5%) operations (both had supracostal puncture), and one required drainage with pigtail. Stone-free status was achieved in 15 (77.8%) operations at 3 months postoperatively. Herein we present a radiation-free 2-step tract dilation technique, which is characterized by ureteroscopic check of the partially dilated tract in between the first dilation with serial fascial dilators and the second dilation with balloon. Our data suggest that it is a safe and effective method.

Single vs Serial Dilatation of Access Tract in Percutaneous Nephrolithotomy: A Randomised Control Study on Its Feasibility and Effects in Management of Renal Calculi

Introduction: Percutaneous Nephrolithotomy (PCNL) is the recommended treatment for renal calculi. The tract dilatation method has a significant effect on the surgical outcome. One- shot Dilatation (OSD) involves dilatation using the dilator and Amplatz of desired size, while Serial Dilatation (SD) involves increasing the dilator size progressively up to the desired size. Aim: To compare the success and complication rates of SD techniques and OSD technique using Amplatz dilators. Materials and Methods: This was a randomised control study, conducted in a Tertiary Care Centre, of Bharati Hospital, Pune, Maharashtra, India, from March 2020 to December 2021. A non-probability sampling technique was followed and hundred consecutive patients of renal calculus were included in the study. The patients were then randomly allocated using random number table to undergo PCNL via a One-shot Dilatation (OSD-group I) or Serial Dilatation (SD-group II) of access tract. After the initial work up, the patients underwent PCNL, tract dilated as per the group enrolled. The two groups were then compared for patient demographics, stone characteristics (size, number, location), dilatation type, access time, tract size, access quality, bleeding at entry, operative time, radiation time, postoperative analgesic requirement, tube or tubeless procedure, time for removal of the nephrostomy tube and double ‘J’ stent placement. The statistical inference was obtained by Analysis of Variance (ANOVA) , Kruskall- Wallis t-test, Fisher’s exact test or Chi-square test. Significance was termed as a p-value<0.05. The analysis was performed on Pvalue.io. Results: In the patients from group I, there was lesser blood loss (Haemoglobin drop 0.9 vs 1.3 gm/dL), clot at entry( 6% vs 28%), and radiation exposure ( 60.9 sec vs 94.1 sec) as compared to group II patients. This was also reflected in reduced mean operative time (46.2 min vs 57.1 min) and lesser duration of hospital stay (3 vs 4 days) among group I patients. conclusion: The OSD was found to be superior to SD using Amplatz dilatation in PCNL in terms of having reduced blood loss and reduced exposure to radiation for the patient.

One-Shot Dilatation vs Metal Dilator During Percutaneous Nephrolithotomy in Flank-Free Supine Position: A Randomized Controlled Study.

Background: The creation and dilatation of the nephrostomy tract is a fundamental step in percutaneous nephrolithotomy (PCNL). In one-shot dilatation (OSD), we used a single Amplatz dilator over a central Alken rod. PCNL in the supine position is as effective and safe as in the prone position. The Barts flank-free modified supine position sums several advantages of the different supine positions. We evaluated the efficacy and safety of OSD compared with metal telescopic dilator (MTD) during PCNL while the patient was in Barts flank-free modified supine position. Materials and Methods: Within 2.5 years, 150 patients with kidney stone candidates for PCNL were randomized into two equal groups according to the dilatation technique. In the OSD group, dilatation was performed using a single Amplatz dilator (30F) and in the MTD group dilatation was performed by sequential MTD (9-30F). All PCNL procedures were done with patients in Barts flank-free modified supine position. Patient characteristics, operative data, and results were collected for statistical analysis. Results: There are no statistically significant differences between both groups regarding patients' characters. The tracts were effectively dilated in all patients. Statistical analyses show a significant difference (p ˂ 0.05) between both groups regarding the time of dilatation (seconds; 68 ± 15 vs 147 ± 18), time of X-ray exposure (seconds; during dilatation; 36 ± 10 vs 61 ± 15 and the total; 157 ± 16 vs 181 ± 20), hemoglobin loss (mg/dL; 0.7 ± 0.2 vs 1.2 ± 0.3), and hospital stay (days; 3 ± 0.6 vs 3.7 ± 0.7) with favorable results to OSD. Complication rates were comparable between the two groups. Conclusions: OSD is efficient as MTD during PCNL while patients are in Barts flank-free modified supine position, with less dilatation time, X-ray exposure, blood loss, and hospital stay than MTD.

The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study.

Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

A novel spherical-headed fascial dilator is feasible for second-stage ultrasound guided percutaneous nephrolithotomy: A pilot study

ObjectiveIn second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL. MethodsThe novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one. ResultsExperimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators (p<0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion. ConclusionThe design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL.

Comparıson of two dıfferent dılatatıon methods ın percutaneous nephrolıthotomy ın term of safety: One-shot dılatatıon versus stage dılatatıon

Background: To compare one-shot and standard stage amplatz dilatation techniques in percutaneous nephrolithotomy (PCNL) in terms of efficacy and safety method performed in the treatment of kidney stones. Materials and Methods: Eighty patients who underwent PCNL were randomly divided into groups according to staged (group 1) or one-shot (group 2) amplatz dilatation. Amplatz dilatation was applied to the patients in group 1, starting from the 8F dilator, up to 30F in a standard manner. Patients in group 2 were dilated directly with a 30F amplatz dilator and both groups were compared in terms of efficacy and safety. Results: Complete stone-free status was achieved in 35 (87.5%) of the patients in group 1 and in 36 (90%) of the patients in group 2 and no statistically significant difference was found between the two groups in terms of stone-free status (p: 0. 72). In group 2, the duration of surgery, dilatation time, and duration of fluoroscopy were significantly shorter (p: 0.001, p: 0.007, p: 0.001). There was no statistically significant difference between the two groups in terms of erythrocyte solution requirement (p: 0. 64). Total complication rates were 15% in both groups, and there was no statistically significant difference between the groups in terms of complication rates (p: 1.00). Conclusions: One-shot amplatz dilatation method provided a significant advantage compared to the staged amplatz dilatation method by providing shorter dilatation time, scopy time and total operation time. In addition, it provided a similar rate of pain score, blood loss and hospital stay, resulting in the conclusion that it was a reliable method as safe as standard amplate dilatation.

Comparison of single-step renal dilatation and serial renal dilatation in percutaneous nephrolithotomy: A retrospective case-control study.

Background:Access to the pelvi-calyceal system and subsequent dilatation of the tract are among the initial important steps in percutaneous nephrolithotomy (PCNL). In this study, we share our experience with single-step renal dilatation when compared to multiple serial renal dilatation in PCNL.Materials and Methods:This is a retrospective study wherein 35 patients who underwent PCNL by single-step renal dilatation by appropriate size Amplatz Dilator were compared with 35 patients who underwent multi-step serial renal dilatation using serial metallic Alken dilators. These patients were analyzed on the basis of demographic profile, total intra-operative time, fluoroscopic time, intra-operative and postoperative complications, stone clearance, requirement of blood transfusion, duration of hospital stay, and follow-up.Results:There were no significant differences in the demographic profile among the patients in these two groups. The mean total operative duration and fluoroscopic duration were less in single step renal dilatation group, and these have been found to be statistically significant (P < 0.05). There were no statistically significant differences in the rates of other complications – incomplete stone clearance, bleeding and hematoma formation, requirement of blood transfusion, duration of hospital stay, and follow-up.Conclusion:Operative duration and rate of radiation exposure are significantly less in PCNL by single-step renal dilatation; however, there is no statistically significant difference in the rates of other complications.

Simultaneous bilateral endoscopic surgery in a pediatric patient: Description of a NOVEL technique

Simultaneous bilateral endoscopic surgery (SBES) is the performance of a percutaneous nephrolithotomy (PCNL) on one side and a retrograde intrarenal surgery (RIRS) on the other kidney simultaneously. Our aim is to report through a video the surgical technique and the step-by-step details of a SBES performed in a pediatric patient. A 12-year-old male patient with bilateral upper tract urolithiasis. Supine PCNL is performed in Galdakao-modified Valdivia position. Ureteroscopic surgeon performs retrograde pyelography on PCNL kidney. Percutaneous access under fluoroscopic guidance trough the lower calyx and dilated with Amplatz dilators to 17.5 Fr. Storz® 17.5 MIP Nephroscope is introduced and fragmentation with pneumatic lithotripter starts. On the other kidney, after introduction of ureteral sheet 12/14 Fr and digital flexible ureteroscope Flex Xc ® 9.5Fr, pulverization of the stone starts with Laser Holmium YAG (Oddysey®). Surgeons work simultaneously and share fluoro-scopic c-arm. SBES can be reproduced in children. Proper planification and preparation of the involved team and OR set up are essential. Further prospective randomized studies are needed to establish safety and efficacy of SBES in pediatric patients.

One Shot Dilatation (OSD) in Percutaneous Nephrolithotomy (PCNL) - A Safe and Feasible Technique

Objective: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in standard percutaneous nephrolithotomy (PCNL). Methods: This is a prospective, single -center study conducted between January 2017 to June 2019. Patients who underwent PCNL using one shot dilatation (21 – 24 Fr) for access in PCNL were included in the study. Access time, fluoroscopy time, successful dilation time, stone free rate, decrease hemoglobin level and transfusion rate, complication rate, length of post operative hospital stay, cost were recorded. Data was analyzed and reported using summary statistics. Results: A total of 30 patients were enrolled in this survey. 30 patients in one shot dilation (OSD) group.The mean age was 39.5 years. Control group of 30 patients were included in standard PCNL procedure where method of tract dilation was done by regid Amplatz dilators. Access time and fluoroscopy time in OSD group was approximately shorter. Statistically it was significant. Successful dilation and stone free rate were subsequently 98% and was significant. Data collected included patient access time, radiation exposure, total operating time, preoperative and postoperative hemoglobin concentrations, tract dilatation failures, complications and transfusions. Conclusion: The use of one shot and standard prone position under general anaesthesia combines the advantages of these both methods including less radiation exposure and shorter access and operative time. One shot dilation technique is safe, economical and feasible technique with added advantage,lesser radiation exposure and lesser chance of blood transfusion. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.114-117

Single-Step Renal Dilatation Is a Novel Technique in Percutaneous Nephrolithotomy: A Prospective Randomised Study

Purpose: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in percutaneous nephrolithotomy (PCNL). Materials and Methods: In a prospective randomised study including 62 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. Results : The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P &lt; 0.05). There were perioperative complications, according to the Clavien grading system, in 15 (25%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. Conclusion : A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.70-73

Comparative study between Amplatz renal dilator vs visual internal urethrotomy (cold knife) for the treatment of male urethral stricture

Aim The study aimed to assess and compare urethral stricture (US) management outcomes, efficiency, and complications, treated by either Amplatz renal dilator or visual internal urethrotomy (VIU). Patients and methods This prospective comparative study was carried out on 88 male patients with stricture urethra. All patients have performed a physical examination, ascending and micturition urethrography, urodynamic, and pelvic ultrasound. The patients were randomized divided into group 1 (Amplatz group) 44 patients treated with Amplatz dilator, and group 2 (VIU group) 44 patients treated with a cold knife. Patients were followed up at 15 days,3,6, and 12 months after the procedure. Result The mean age was 41.2 (22–73) years. The mean stricture length in group 1 and group 2 was 1.01 ± 0.40 and 1.04 ± 0.30, respectively (p = 0.421). The average IPSS score at baseline for group 1 and group 2 was 21.2 and 21.9 points, respectively. During the 12 months follow-up, IPSS improved, with average scores of 16.1 and 17.3 for group 1 and group 2, respectively (p > 0.05). The mean values of (Q max) between group 1 and group 2 at baseline, day 15, day 90 and 180 days showed no significant difference but at 12 months, (Q max) showed a higher significant difference in group 1 than group 2 (p = 0.003). The post-void residual (PVR) displayed a significant decline in both groups from baseline. After 1 year, PVR showed that group 2 was a little higher than group 1 (no significance) compared to baseline The procedures were found effective without recurrence in all patients (both groups) during the 12 months (Q max > 15m/s). However, group 2 reported (11.4%) intra-operative bleeding, and (6.8%) extravasations. Conclusion The guided urethral dilation and internal urethrotomy are safe, short time procedures, and offer satisfactory results with the advance to VIUD in Qmax at 12 months. No recurrence was documented in both groups after 12 months. VIU reported 18% intraoperative complication.

Percutaneous nephrolithotomy: Three-needle technique on two planes. Cury's technique.

Percutaneous nephrolithotomy is the main type of surgery indicated for kidney stones larger than 2 cm. The present study describes a three-needle technique for percutaneous nephrolithotomy on two planes. The patient is first placed in the lithotomy position for cystoscopy, which guides the ureteral and urethral catheter. Next, the patient is placed in ventral decubitus for the three-needle technique. With the aid of the nephroscope, the first needle is positioned in the projection of the renal pelvis, the second needle is placed in the most posterior of the inferior calyces and the third needle is aligned with the other two at the most depressible point determined by the surgeon's index finger. After alignment in the topography of the third needle, an incision is made with the scalpel 1-2 cm perpendicular to the aponeurosis of the latissimus dorsi muscle. The second needle is replaced with a peridural needle, which is used to confirm the location of the inferior renal calyx and limit the depth of the Chiba needle inserted in the topography of the third needle, forming a 90° angle with the peridural needle. The Chiba needle enables the passage of the guidewire and subsequent dilatation until the 30F caliber for the passage of the Amplatz dilator, initiating the conventional procedure. The technique described has been used at our service for 15 years and has the advantages of less morbidity, fewer complications and less use of the nephrostomy tube. The technique is also easy to learn and highly reproducible.

Effectiveness and safety of four tract dilation methods of percutaneous nephrolithotomy: A meta-analysis.

Percutaneous nephrolithotomy (PCNL) has become a routine surgical procedure for treating patients with large kidney stones; the fundamental step in this process is the creation of the nephrostomy tract. In the present study, a meta-analysis was performed to compare the effectiveness and safety of different tract dilation techniques for PCNL. Databases were searched from inception to 1 April 2019 to identify relevant randomized controlled trials. The X-ray exposure time, hemoglobin decrease, stone-free rate, transfusion rate, hospital stay and the complication rate associated with the various techniques were analyzed. A total of 11 studies comprising 1,415 cases were enrolled in the meta-analysis. Significant differences in X-ray exposure time [weighted mean difference (WMD), 30.67; 95% confidence interval (CI), 20.08-41.26; P<0.001] and hemoglobin decrease (WMD, 0.19; 95%CI, 0.15-0.23; P<0.001) were identified between metal telescopic dilation (MTD) and one-shot dilation (OSD). A significantly lower hemoglobin decrease was observed in the balloon dilation (BD) vs. fascial Amplatz dilation (AD) group [WMD, -0.65; 95%CI, -(0.77-0.52); P<0.001]. The transfusion rate was similar between these techniques. The MTD had an obviously higher successful dilation rate compared with that of the OSD, but no significant differences in stone-free rate and transfusion rate were obtained. The present study determined that, compared with other methods, OSD was safer in almost every adult patient, including those that had previously undergone renal surgery; though it is recommended that this should be performed by experienced surgeons. BD was reported to be effective and safer in patients without a history of renal surgery compared to other methods. The present study proposed AD and MTD as safer methods of dilation for patients who have previously undergone kidney surgery.

Comparison of Urethral Dilation with Amplatz Dilators and Internal Urethrotomy Techniques for the Treatment of Urethral Strictures.

The most common option for the management of urethral stricture (US) is direct visual internal urethrotomy (DVIU), because it is an easy and minimally invasive technique but the low success and high recurrence rates of this technique make urologists research for different types of therapeutic alternatives in stricture treatment. In this study we aimed to compare the internal urethrotomy with amplatz dilation for the treatment of male US. A total of sixty patients, who have been operated due to urethral stricture were enrolled into this study. Group 1 was treated with amplatz renal dilators and the group 2 was treated with cold knife urethrotomy. All patients were evaluated for Qmax preoperatively and at the first, 3rd, 9th and 12th months postoperatively. In the 3 month uroflowmetry results, mean Q max values were 15.6±2 ml/sec in amplatz group and 15.5±1.6 ml/sec in DVIU group. There was no statisticaly difference between the two groups. However the Q max values in the postoperative 9 and 12 months were significantly decreased in the DVIU group. In the DVIU group 9 recurrences (36%) appeared and 2 of these reccurrences were in the first 3 months, whereas in the amplatz group no recurrences appeared in the first 3 months. The urethral stricture recurrence rate up to the 12 month follow up was statistically significant for group 1 when it is compared with group 2.Conclusions: In our experience, amplatz dilation is a good option as the initial treatment for urethral stricture.

Trends of percutaneous nephrolithotomy in Saudi Arabia.

Objective:The objective of the study was to present the current practice patterns on percutaneous nephrolithotomy (PCNL) in Saudi Arabia and to compare it with the international patterns and to observe the adherence to the guidelines.Materials and Methods:A survey consisting of 28 questions was sent to urologists working in Saudi Arabia using a Google Forms questionnaire. The questioner covered most aspects of performing PCNL starting from preparing the patient till discharging him.Results:One hundred and thirty-two replied to the survey. Almost 70.2% performed PCNL and 59.1% of them learned PCNL during residency. The access was obtained by the urologists in 80.3% from the participants, 68.2% of them uses fluoroscopic guidance for the puncture. The majority (80.3%) perform PCNL in the prone position. Nearly 69.7% use the balloon dilators and 16.7% use the Amplatz dilators. For kidney drainage, 60.6% place a nephrostomy tube and a double-J stent (DJ stent) together and 4.5% perform tubeless PCNL (DJ stent only). About 45.5% stated that the introduction of flexible ureteroscopy decreased the rate of doing PCNL for >20%.Conclusions:Data obtained from a group of urologists in Saudi Arabia showed that the majority of urologists practicing in Saudi Arabia perform PCNL. They usually learn PCNL during residency. We observe that the majority of urologists attach to the original patterns in PCNL, i.e., they predominantly prefer the prone position and use fluoroscopy to gain the PCNL access. Furthermore, the data showed that new trends in PCNL did not gain a lot of momentum as few practices miniaturized PCNL and tubeless PCNL. The majority use balloon dilators and combined ultrasonic/pneumatic lithotripters. The complication rate encountered by the participants is concomitance with the published international figures. The introduction of flexible ureteroscopy highly decreased the rate of doing PCNL for most urologists.