Use of Amplatz Sheath in Percutaneous Nephrolithotomy and effect of its various sizes: Randomized Controlled Trial | [Pakistan Journal of Medicine and Dentistry • 2020]

Author(s):

1. Jahanzeb Shaikh: The Kidney Centre, Postgraduate Training Institute, Karachi, Pakistan

2. Salman Khalid: The Kidney Centre, Postgraduate Training Institute, Karachi, Pakistan

3. Adnan Siddiq: The Kidney Centre, Postgraduate Training Institute, Karachi, Pakistan

4. Shoaib Mithani: The Kidney Centre, Postgraduate Training Institute, Karachi, Pakistan

5. Sherjeel Saulat: Tabba Kidney Institute,Karachi,Pakistan

6. Imran Sharif: The Kidney Centre, Postgraduate Training Institute, Karachi, Pakistan

Abstract:

Background: Nephrostomy tract itself is the most common source of hemorrhage during percutaneous nephrolithotomy, which can be avoided by puncturing through the calyx with minimal angulation between calyceal system and the nephroscope shaft. Smaller the sheath diameter, lesser would be the bleeding. Our objective was to compare mean change in hemoglobin (HB) level in patients undergoing percutaneous nephrolithotomy (PCNL) with 24 versus 30 French Amplatz sheath. Methods: In this study, 142 patients were randomly divided into Group A undergoing procedure with 24 French Amplatz sheath; and Group B with 30 French sheath. At the end of procedure in both groups, nephrostomy tube was kept for 24 hours. On first post-operative day, patients' HB was checked and compared with pre-operative data, along with blood transfusion rates. SPSS 20 was used for data analysis and p-value < 0.05 was considered significant. Results: Median age and interquartile range of Group-A and Group-B patients was (40; 18) and (41; 21) years respectively. While stone size of Group-A and Group-B patients reported as (2.0; 0.60) and (2.1; 0.70) cm. The operative time and interquartile ratio of Group-A and Group-B patients was (75; 45) and (85; 45) minutes and we found significant change in HB of Group-A (0.90; 0.80) with Group-B patients (1.90; 0.70) gm/dl respectively [p = 0.000]. Conclusion: It was observed that use of 24 French Amplatz sheath lead to less renal hemorrhage and less hemoglobin drop compared to standard 30 French Amplatz sheath. Thus, small size Amplatz sheath in percutaneous nephrolithotomy may be considered effective and safe option for treatment of renal stones.

Page(s): 37-41

DOI: 10.36283/PJMD9-3/008

Published: Journal: Pakistan Journal of Medicine and Dentistry, Volume: 9, Issue: 3, Year: 2020

Keywords:

Hemoglobin , bleeding , Percutaneous Nephrolithotomy , Amplatz , Kidney Stones

References:

[1] Shaikh Jahanzeb,Siddiq SK,Mithani A,Saulat S,Sharif S,I S .2020 .Use of amplatz sheath in percutaneous nephrolithotomy and effect of its various sizes: randomized controlled trial. J Med Dent, 10(3) : 008-41.

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