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Can Color Doppler Ultrasound Challenge the Paradigm in Percutaneous Nephrolithotomy?

Ying Shi1, Xiong Yang1, Bryan J Mathis2

  • 1Department of Urology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.

Journal of Endourology
|September 27, 2021
PubMed

Insights

Color Doppler ultrasound-guided puncture significantly reduces bleeding complications during percutaneous nephrolithotomy (PCNL). This method targets the avascular area, leading to lower tract bleeding and improved patient outcomes compared to standard Type-B ultrasound guidance.

Area of Science:

  • Urology
  • Medical Imaging
  • Surgical Complications

Background:

  • Percutaneous nephrolithotomy (PCNL) is a common procedure for kidney stone removal.
  • Hemorrhagic complications can occur during PCNL, potentially increasing morbidity.
  • Identifying and avoiding vascular structures during puncture is crucial for minimizing bleeding.

Purpose of the Study:

  • To compare the efficacy of color Doppler ultrasound-guided puncture versus conventional Type-B ultrasound-guided puncture in reducing hemorrhagic complications of PCNL.
  • To evaluate the impact of targeting the avascular area of the target fornix on bleeding and other outcomes.

Main Methods:

  • A prospective study involving 348 patients undergoing PCNL, divided into a color Doppler group (231 cases) and a Type-B ultrasound group (117 cases).
  • The color Doppler group targeted the avascular area, while the Type-B group used the default puncture point.
  • Key outcomes analyzed included tract bleeding, operation time, postoperative hemoglobin levels, and stone-free rates.

Main Results:

  • Color Doppler imaging identified significant arterial variations in 35.1% of cases.
  • The color Doppler group showed significantly lower tract bleeding (10.8% vs. 24.8%) and postoperative hemoglobin reduction.
  • Postoperative hospitalization was shorter in the color Doppler group, despite a slightly longer working channel creation time.

Conclusions:

  • Vascular variations in the kidney fornix are common, necessitating precise puncture techniques.
  • Targeting the avascular area using color Doppler ultrasound guidance effectively reduces tract bleeding and postoperative hemoglobin decrease during PCNL.
  • Color Doppler ultrasound-guided puncture is a valuable technique for minimizing severe hemorrhagic complications in PCNL.

Keywords:
Doppler Colorhemorrhagenephrolithotomypercutaneouspuncturesultrasonography

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