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

IF 0.7 Q4 UROLOGY & NEPHROLOGY Urology Annals Pub Date : 2023-04-01 Epub Date: 2023-01-16 DOI:10.4103/ua.ua_25_22
Arman Tsaturyan, Constantinos Adamou, Lampros Pantazis, Christina Kalogeropoulou, Vasiliki Tzelepi, Dimitris Apostolopoulos, Konstantinos Pagonis, Angelis Peteinaris, Anastasios Natsos, Theofanis Vrettos, Abdulrahman Al-Aown, Evangelos Liatsikos, Panagiotis Kallidonis
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Abstract

Purpose: 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.

Materials and methods: 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.

Results: 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.

Conclusions: 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.

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经皮肾扩张技术对肾实质损伤的影响:一项在猪模型上的体内实验研究。
目的:本研究的目的是评估猪模型经皮肾取石术中两步扩张与传统Amplatz渐进扩张的肾实质损伤。材料和方法:在荧光镜引导下,在四只雌性猪的两个肾脏建立了非毛细管经皮穿刺通道。在每只猪的右肾上,使用Amplatz扩张器组进行逐渐扩张,逐渐扩张至30Fr,而在左肾上,仅使用16Fr和30Fr扩张器进行两步扩张。其中两只动物在手术后立即实施安乐死,其余两只在1个月后实施安乐死。存活的猪在术后立即、15天和30天接受了增强计算机断层扫描。二巯基丁二酸(DMSA)闪烁扫描和单光子发射计算机断层扫描(CT)也在最后一次CT后进行,之后处死猪。采集所有肾脏进行病理学检查。结果:随访的放射学成像显示,比较的扩张技术造成了类似的实质损伤,并且在随后的扫描中预期疤痕大小会减小。DMSA在任何肾脏中均未发现瘢痕。对手术后立即收获的肾脏和待愈合的动物肾脏进行的大体和显微镜检查均显示,根据扩张方法,组织损伤、纤维化程度或炎症没有显著差异。结论:我们的研究表明,与非毛细管穿刺后肾实质损伤的逐渐扩张相比,两步扩张不会导致较差的结果。事实上,术后影像学结果表明,当使用两步方法时,有更好的愈合和更少疤痕组织的趋势。
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来源期刊
Urology Annals
Urology Annals UROLOGY & NEPHROLOGY-
CiteScore
1.20
自引率
0.00%
发文量
59
审稿时长
31 weeks
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