Pulsed versus continuous mode fluoroscopy during PCNL: safety and effectiveness comparison in a case series study

Area of Science:

• Urology
• Medical Imaging

Background:

• Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
• Fluoroscopy is essential for guiding PCNL, but involves radiation exposure.
• Optimizing fluoroscopy techniques can reduce patient and staff radiation dose.

Purpose of the Study:

• To compare total fluoroscopy time (FT) between continuous fluoroscopy (SF) and pulsed fluoroscopy (PF) modes in PCNL.
• To assess the impact of fluoroscopy mode on stone-free rates and complications.
• To evaluate the safety and efficacy of pulsed fluoroscopy in PCNL.

Main Methods:

• A cohort of 111 patients undergoing PCNL by a single surgeon was analyzed.
• Patients were divided into two groups: standard continuous fluoroscopy (SF) and pulsed fluoroscopy (PF).
• Renal access was guided by ultrasound in both groups; stone complexity was assessed using Guy's stone score (GSS).

Main Results:

• Median FT was significantly lower in the PF group (76.8 s) compared to the SF group (155.4 s) (p < 0.001).
• Stone-free rates showed a trend towards improvement with PF across different GSS categories, particularly for GSS 2 and 3.
• Complications and presence of residual fragments were comparable between the SF and PF groups.

Conclusions:

• Pulsed fluoroscopy significantly reduces fluoroscopy time and radiation exposure during PCNL compared to continuous fluoroscopy.
• The use of pulsed fluoroscopy does not compromise the safety or efficacy of PCNL.
• Pulsed fluoroscopy is a viable alternative for reducing radiation dose in PCNL procedures.