Comparative study of degree of renal trauma between Amplatz sequential fascial dilation and balloon dilation during percutaneous renal surgery in an animal model.

OBJECTIVES: To compare two commonly used methods of dilation, the Amplatz sequential fascial (ASF) and the balloon dilator, in a porcine model.
METHODS: Fourteen kidneys from 9 female pigs were used for this experiment. One kidney of each pig underwent ASF dilation and the other underwent balloon dilation using the Nephromax balloon. This was achieved after percutaneous renal puncture with an 18-gauge needle under fluoroscopic guidance. The effects of both methods of dilation were assessed immediately in 1 pig, after 24 hours in 3 pigs, at 4 weeks in 4 pigs, and at 6 weeks in 1. The animals were killed, and the kidneys were removed for gross and histologic examination.
RESULTS: Grossly, the ASF dilated tracts appeared rounded and the balloon dilated tracts appeared V-shaped with lateral fragmentation within 24 hours. No obvious gross differences were noted at 4 to 6 weeks between the two methods of dilation, with both appearing as fine scars. Histologically, minor differences were seen at 4 to 6 weeks, with slightly more abscesses and larger scar formation in the kidneys that underwent ASF dilation than in the balloon dilation group.
CONCLUSIONS: In this porcine animal model, the degree of renal trauma induced by the ASF dilators and the balloon dilators during percutaneous renal surgery seems to be comparable. The acute and chronic renal parenchyma effects of both methods of tract dilation were almost similar. The choice of nephrostomy tract dilation should be by physician preference.