One-stage tract dilation for percutaneous nephrolithotomy: Is it justified?

Purpose: To assess the feasibility of one-stage acute dilation of the nephrostomy tract with a 30F Amplatz dilator in patients who are candidate for percutaneous nephrolithotomy (PCNL) regardless of whether there is a previous renal scar to make the procedure less time consuming and more cost effective. Patients and Methods: The outcomes of one-stage tract dilation for PCNL in 100 consecutive patients with and without a history of ipsilateral open stone surgery (OSS), treated by one surgeon, were examined prospectively. Forty-six patients (group 1) had a history of ipsilateral OSS, and 54 patients (group 2) did not have this history. Demographic data as well as intraoperative information, such as access time and radiation exposure time during access, were recorded. The success of the access technique and its bleeding complications were analyzed between the two groups. Results: By applying a "one-stage" technique, the targeted calix could be entered with a success rate of 93%. There was no difference in the procedural success rate between groups 1 and 2 (93.5% v 92.6%, respectively). All seven failed attempts (7%; three with previous OSS) were managed successfully using an Alken dilator to gain access to the proposed calix in the same session. Previous OSS did not impact access time, radiation exposure time during access, postoperative hemoglobin drop, and bleeding complications. There were no visceral and vascular injuries. Conclusions: One-stage tract dilation for PCNL is a safe and effective method in almost every adult patient.