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Pure Ultrasound with Two-Step Dilation vs. Combined Ultrasound-Fluoroscopy in Percutaneous Nephrolithotomy: Is
Enrique Pulido-Contreras1, Miguel Angel Garcia-Padilla1, Carlos Rios Melgarejo1
1Urology Department, Unidad Médica de Alta Especialidad No. 1 Bajío, Instituto Mexicano del Seguro Social, León, México.
Urology Research & Practice
|April 6, 2026
Summary
Pure ultrasound percutaneous nephrolithotomy (PCNL) is safe and effective, achieving similar stone-free rates to traditional methods. This technique offers a valuable alternative to reduce radiation exposure during PCNL procedures.
Area of Science:
- Urology
- Medical Imaging
Background:
- Fluoroscopy is the standard guidance for percutaneous nephrolithotomy (PCNL), but poses radiation risks.
- Ultrasound (US) guidance is emerging as a safer alternative.
Purpose of the Study:
- To evaluate the safety and outcomes of pure-ultrasound PCNL with two-step tract dilation.
- To compare pure-ultrasound PCNL with combined ultrasound-fluoroscopy techniques.
Main Methods:
- Retrospective analysis of 100 patients undergoing PCNL from March 2019 to October 2023.
- Group 1: All PCNL steps performed under ultrasound guidance.
- Group 2: Tract dilation, stone clearance confirmation, and exit strategy used fluoroscopy.
Main Results:
- Pure ultrasound PCNL (Group 1) showed no fluoroscopy time, compared to 20 seconds in Group 2 (P < .001).
- Lower complication rates were observed in Group 1 (10%) versus Group 2 (17%), though not statistically significant (P = .27).
- Global stone-free rates were high and similar between groups (78.3% in Group 1 vs. 80% in Group 2, P = 1.0).
Conclusions:
- Pure ultrasound PCNL is a safe and effective alternative to fluoroscopy-guided PCNL.
- This method significantly reduces radiation exposure without compromising stone-free rates.
- Pure ultrasound PCNL with two-step dilation is a viable option for stone removal.
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