Percutaneous nephrolithotomy with and without retrograde pyelography: a randomized clinical trial

Area of Science:

• Urology
• Nephrology
• Surgical Innovation

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for managing kidney stones.
• Techniques for accessing the pyelocalyceal system have evolved, including using opaque stones as landmarks.
• The role of retrograde pyelography in PCNL remains a subject of investigation.

Purpose of the Study:

• To compare the clinical outcomes of percutaneous nephrolithotomy (PCNL) with and without the use of retrograde pyelography.
• To evaluate the efficacy and safety of omitting retrograde pyelography in PCNL procedures.

Main Methods:

• A randomized clinical trial involving 55 patients with opaque renal calculi undergoing PCNL.
• Patients were randomized into two groups: noncatheterized (intervention) and catheterized (control) for retrograde pyelography.
• Outcomes, including residual stone, postoperative fever, and complications, were assessed.

Main Results:

• No significant differences were observed in stone-free rates, operative time, or hospital stay between the groups.
• Postoperative hemoglobin decrease was higher in the control group but without clinical significance.
• No differences in fever, radiation exposure, or overall clinical outcomes were noted.

Conclusions:

• Catheter insertion for retrograde pyelography does not appear to offer significant advantages in major clinical outcomes for PCNL.
• The findings suggest that omitting retrograde pyelography may be a viable option in certain PCNL cases.
• Further research may explore specific patient subgroups where retrograde pyelography could still be beneficial.