Blind versus fluoroscopy-guided percutaneous nephrolithotomy: a randomized clinical trial

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) involves radiation exposure risks for patients and surgical teams.
• Conventional PCNL access relies heavily on fluoroscopy, necessitating radiation shielding and limiting its use in certain scenarios.

Purpose of the Study:

• To evaluate the success rate and complication profile of blind PCNL access guided by the lumbar notch landmark.
• To compare the efficacy of blind PCNL access with conventional fluoroscopy-guided access.

Main Methods:

• A randomized clinical trial involving 100 patients undergoing PCNL.
• Patients were assigned to either blind access using the lumbar notch or conventional fluoroscopy-guided access.
• Success rates and operative times were compared between the two groups, with postoperative assessments including X-ray and ultrasonography.

Main Results:

• Successful puncture rates were 86% for blind access and 94% for fluoroscopy-guided access (P = .18).
• Overall procedure success rates were 80% for blind access and 88% for fluoroscopy-guided access (P = .27).
• Mean access and operation times were statistically similar between the groups.

Conclusions:

• Blind PCNL access using the lumbar notch is a safe and effective technique.
• This method is recommended for skilled endourologists, particularly for patients with large hydronephrotic kidneys, to minimize radiation exposure.