Balloon Dilation versus Amplatz Dilation in Totally Ultrasound-guided Percutaneous Nephrolithotomy: a retrospective analysis of efficacy and safety

Purpose To compare the efficacy and safety of Balloon dilation (BD) versus Amplatz dilation (AD) in totally ultrasound-guided percutaneous nephrolithotomy (PCNL), and to investigate the optimal method of percutaneous tract creation in PCNL. Methods This retrospective study collected clinical data from 686 patients who underwent PCNL between January 2017 and December 2022. These patients were divided into two groups based on the tract dilation method employed during PCNL. Group BD included 325 patients who underwent Balloon dilation, while Group AD consisted of 361 patients treated with Amplatz dilation. Patients’ demographic data, perioperative outcomes and clinical efficacy of the two groups in the treatment of upper urinary tract stones were compared. Results The two groups were similar in terms of gender, age, stone size, Hounsfield units of stone, preoperative urine white blood cell (WBC), preoperative urine bacterial count and degree of hydronephrosis. The BD group exhibited a significantly higher stone-free rate (SFR) 1 day postoperatively (76.0% vs. 64.0%, P  = 0.001), a higher SFR at 1 month postoperatively (77.8% vs. 70.4%, P  = 0.026) and showed a lower hemoglobin drop (12.9 ± 19.1g/L vs. 17.2 ± 15.2 g/L, P  = 0.001), less intraoperative blood loss (50.9 ± 65.9ml vs. 89.6 ± 85.1 g/L, P  < 0.001) and a lower secondary surgery rate (9.2% vs. 14.6%, P  = 0.029) compared to the AD group. In terms of postoperative perirenal hematoma rate, blood WBC, blood neutrophil proportion (NEUT%), C-reactive protein (CRP), visual analogue scale (VAS) pain score and overall complication rate, the BD group was significantly lower than the AD group. There were no significant differences in operation time, transfusion rate, length of hospitalization, postoperative serum procalcitonin (PCT) and serum creatinine. Conclusion Totally ultrasound-guided Balloon dilation demonstrates a higher SFR compared to Amplatz dilation, while also reducing blood loss, inflammatory response and the incidence of complication, making it a promising approach for PCNL.