Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy...

Area of Science:

• Urology
• Medical Imaging
• Radiation Safety

Background:

• Fluoroscopy during percutaneous nephrostolithotomy (PN) significantly contributes to patient radiation exposure.
• Minimizing radiation dose is crucial for patient safety and compliance with radiation protection principles.

Purpose of the Study:

• To compare fluoroscopy times and treatment outcomes before and after implementing a reduced fluoroscopy protocol during PN.
• To evaluate the safety and efficacy of a novel protocol aimed at decreasing radiation exposure.

Main Methods:

• Retrospective review of 80 patients undergoing PN (40 pre-protocol, 40 post-protocol).
• The reduced protocol incorporated visual/tactile cues, fixed lower mAs/kVp, laser guidance, a dedicated technician, and single pulse per second fluoroscopy.
• Preoperative characteristics, fluoroscopy/operative times, complications, and success rates were analyzed.

Main Results:

• Fluoroscopy time decreased by 80.9% (175.6 to 33.7 seconds, p<0.001) post-protocol implementation.
• No significant differences were observed in body mass index, stone size, success rate, operative time, or complications between groups.
• The pre-protocol group had a slightly longer average hospital stay (3.9 vs 3.6 days, p=0.027).

Conclusions:

• The reduced fluoroscopy protocol significantly decreased radiation exposure during PN by 80.9%.
• This protocol maintained comparable success rates, operative times, and complication profiles to the conventional technique.
• Adoption of this protocol offers a safe method to reduce radiation exposure for patients, surgeons, and staff during PN.