Limiting radiation exposure during percutaneous nephrolithotomy

An increase in the prevalence of urologic stone disease and the refinement of endourologic techniques has seen a concomitant rise in the use of fluoroscopy during surgery. As such, there has been increasing concern in regard to the intraoperative radiation exposure to both clinicians and patients. The objective of the study was to audit contemporary data on radiation exposure during percutaneous nephrolithotomy (PCNL), in comparison with published series, and demonstrate that relatively low levels are achievable with clinical vigilance and attention to technique Methods: A retrospective analysis was performed of all PCNLs undertaken between July 2005 and December 2011. The primary outcome measure was fluoroscopy times and associated radiation exposure, measured as dose area product (DAP). No statistical analysis was undertaken.

Between July 2005 and October 2011, 376 PCNLs were performed. Data were available on 348 patients including 16 pediatric patients. Mean DAP and screening time (ST) over the whole study period were 45 cGy/cm(2) and 96s, respectively. On a year by year basis, the ST and DAP reduced from 917 to 375 and from 180 to 65, respectively. We acknowledge the limitation of this being a retrospective case series.

This study represents the largest series to date on radiation exposure during PCNL and compares favorably with other published series, including those purporting novel techniques. Subtle changes in surgical technique and experience over time can lead to low screening times and can be potentially achieved by all operators performing PCNL within a high throughput center. It is now recognized that surgical outcome in stone surgery is related to caseload. The radiation dose the patient receives during PCNL is increasingly recognized to be an important factor and can be reduced by careful technique and experience.