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Ultrasound-guided percutaneous nephrolithotomy: Advantages and limitations.

Foo Cheong Ng1, Wai Loon Yam1, Tze Ying Benjamin Lim1

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Ultrasound-guided access percutaneous nephrolithotomy (USGA-PCNL) offers comparable stone outcomes to fluoroscopy-guided access PCNL (FGA-PCNL) and reduces organ injury risk. The learning curve for USGA-PCNL is minimal, making it a safe alternative.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Medical Imaging

Background:

  • Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
  • The effectiveness of ultrasound guidance for PCNL access has been debated.
  • Comparing ultrasound-guided access PCNL (USGA-PCNL) with fluoroscopy-guided access PCNL (FGA-PCNL) is crucial for optimizing outcomes.

Purpose of the Study:

  • To compare operative outcomes, postoperative outcomes, and complication rates between USGA-PCNL and FGA-PCNL.
  • To evaluate the safety and efficacy of ultrasound guidance in PCNL access.
  • To determine if USGA-PCNL offers advantages over FGA-PCNL in clinical and stone outcomes.

Main Methods:

  • A retrospective analysis of 184 consecutive PCNL patients (72 USGA-PCNL, 112 FGA-PCNL) from July 2008 to September 2014.
  • Patient demographics, stone characteristics, and operative details were compared between the two groups.
  • Outcomes assessed included stone-free rates, complication rates (Clavien-Dindo), and need for secondary procedures.

Main Results:

  • No significant difference in stone-free rates between USGA-PCNL and FGA-PCNL.
  • Higher rates of upper pole, mid pole, and multiple pole punctures were observed in the USGA-PCNL group (p=0.027).
  • USGA-PCNL eliminated the risk of organ injuries during puncture, unlike FGA-PCNL which had one case of pneumothorax.

Conclusions:

  • Ultrasound-guided access during PCNL significantly reduces the risk of inadvertent organ injuries.
  • USGA-PCNL demonstrates comparable operative and stone outcomes to FGA-PCNL.
  • The learning curve for USGA-PCNL is minimal, suggesting it is a safe and effective alternative to conventional FGA-PCNL.