Trends in Urologic Cancer Surgical Volumes and Post-Operative Length of Stay during the COVID-19 Pandemic

ABSTRACT

Introduction &Objective: Single step dilation technique has been reported to be safe and effective. In contrast, other reports have shown that single step dilation may cause more trauma to the renal parenchyma than sequential dilation. Data on the use of this technique during pediatric PCNL in the literature are sparse. In this study, we aimed to compare the safety, efficacy and perioperative complications of single step versus serial tract dilation, using Alken metal telescopic dilators during pediatric PCNL. Method(s) Between April 2017 and May 2020, all children who were candidates for PCNL were enrolled in this prospective randomized study. Patients were randomized between the two treatment groups according to the dilation technique used. In group A. Alken telescopic metal dilation was employed, and in group B, single step dilation technique was performed. The primary outcomes were access time and dilation fluoroscopy time. The secondary outcomes were tract dilation time, operative time, stone free rate, complications rate, postoperative hospital stay, haemoglobin deficit, and need for blood transfusion. Result(s) There were no differences in demographic characteristics, operative duration, total fluoroscopy time and postoperative hospital stay between the two groups. Access was successfully obtained in all procedures. We did not encounter any difficulties in tract dilation in either technique. All of the procedures were performed through a single tract. Access time and dilation fluoroscopy time was statistically significantly shorter in group B compared to group A (p = 0.034 and 0.042, respectively). The overall complication rate was 21.4% in all patients (25.7% in group A and 17.1% in group B). There were no major complications (modified Clavien IV or higher) in the study population. The mean haemoglobin deficit before and after surgery was not significantly different between the two groups (p = 0.517). There overall stone-free rates at one month was similar for the two groups (33/35, 94.3%). Conclusion(s) Compared with serial metal track dilation, single step dilation technique showed comparable safety and efficacy during pediatric PCNL, with significantly reduced access time and dilation fluoroscopy time.