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Tract creation using plasma vaporization versus metal dilatation in percutaneous nephrolithotomy: A propensity score‐matched analysis
Author(s) -
Chang YinLun,
Chiang PoHui,
Cheng YuanTso,
Lee WeiChia
Publication year - 2019
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.13843
Subject(s) - medicine , percutaneous nephrolithotomy , propensity score matching , odds ratio , confidence interval , perioperative , surgery , urology , blood transfusion , renal function , percutaneous
Objectives To share our 10‐year experience of tract creation by using plasma vaporization compared with metal dilatation in percutaneous nephrolithotomy. Methods We retrospectively reviewed the medical records of 230 patients who had undergone 244 percutaneous nephrolithotomy procedures at Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, from January 2007 to December 2016, and divided the patients into the plasma ( n = 130) and metal ( n = 114) groups. All patients underwent percutaneous nephrolithotomy by either a bipolar resectoscope mounted with a plasma vaporization button electrode or metal dilatation for tract creation. Propensity score matching was applied to reduce selection bias. Perioperative and postoperative data analysis included procedure time, length of hospital stay, blood transfusion rate, any early and late complications, stone‐free rate, renal function, and time of need for pain control. Results Before propensity score matching, there were significantly shorter hospital stay (2.6 vs 3.8 days, P < 0.01), less operating time (66.1 vs 108.1 min, P < 0.01) and no blood transfusion rate (0 vs 4 [3.5%], P = 0.031) in the plasma vaporization group. After propensity score matching, there was no statistically significant difference in the patients’ baseline characteristics. There were significantly shorter hospital stay (odds ratio 0.46, 95% confidence interval 0.32–0.66; P < 0.001) and shorter average operating time (odds ratio 0.98, 95% confidence interval 0.97–0.99, P < 0.001) in the plasma vaporization group. Conclusions In comparison with metal dilatation, the plasma vaporization technique is a safe and effective method for creating the nephrostomy tract for percutaneous nephrolithotomy, based on shorter postoperative stay, less operating time, zero blood transfusion rate, acceptable stone‐free rate and no major complications.