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Ultrasound-Only Percutaneous Nephrolithotomy Is Safe and Effective Compared to Fluoroscopy-Directed Percutaneous
Gregory W Hosier1, Nizar Hakam2, Fadl Hamouche2
1Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, Canada.
Journal of Endourology
|April 13, 2023
Summary
Ultrasound-only percutaneous nephrolithotomy (PCNL) offers similar stone-free rates and safety compared to fluoroscopy-guided PCNL. This radiation-free approach also reduces operative time.
Area of Science:
- Urology
- Medical Imaging
- Nephrolithiasis Treatment
Background:
- Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
- The role of ultrasound-only guidance in PCNL, avoiding fluoroscopy, requires further investigation regarding its efficacy and safety.
- Fluoroscopy use in PCNL contributes to radiation exposure for both patients and medical staff.
Purpose of the Study:
- To compare the outcomes of ultrasound-only percutaneous nephrolithotomy (PCNL) versus fluoroscopy-directed PCNL.
- To evaluate complication rates, stone-free status, and operative times between the two PCNL techniques.
- To determine if ultrasound-only PCNL is a safe and effective alternative to fluoroscopy-directed PCNL.
Main Methods:
- A prospective study analyzing data from the Registry for Stones of the Kidney and Ureter database (2015-2021).
- Comparison of outcomes between 141 patients undergoing ultrasound-only PCNL and 147 patients undergoing fluoroscopy-directed PCNL.
- Statistical analysis included adjustment for body mass index, ASA score, stone size, and Guy score; odds ratios (OR) and confidence intervals (CI) were calculated.
Main Results:
- No significant difference in complication rates (15% vs. 16%, p=0.87) or stone-free rates (71% vs. 65%, p=0.72) between ultrasound-only and fluoroscopy-directed PCNL.
- Ultrasound-only PCNL was associated with significantly shorter operative times (median 99.5 vs. 126 minutes, p<0.001).
- Patients undergoing ultrasound-only PCNL avoided a mean radiation dose of 10 mGy per procedure.
Conclusions:
- Ultrasound-only PCNL is a safe and effective alternative to fluoroscopy-directed PCNL for kidney stone treatment.
- The technique achieves comparable stone-free rates to traditional fluoroscopy-guided methods.
- Ultrasound-only PCNL offers the significant advantage of eliminating radiation exposure and reducing operative time.
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