Effect of leaded gloves on patient and surgeon radiation exposure in percutaneous nephrolithotomy: A prospective...

Ionizing radiation exposure is a significant occupational hazard for urologists performing percutaneous nephrolithotomy (PCNL). Surgeon hands are particularly vulnerable during fluoroscopic access. Leaded gloves are a proposed mitigation strategy. This prospective pilot study evaluated surgeon hand and patient collar radiation exposure during PCNL with standard vs leaded gloves.

Twenty patients were prospectively allocated to standard or leaded glove groups in sequential fashion. All cases were performed by a single high-volume endourologist with patients in the prone position. Clinical variables including BMI, operative time, stone size, and fluoroscopy dose were recorded. Surgeon hand exposure was measured using ring dosimeters. Patient exposure was measured with clip-on dosimeters at the collar, reported as deep dose equivalent (DDE), lens dose equivalent (LDE), and shallow dose equivalent (SDE).

At baseline, patient BMI (p = 0.005) and fluoroscopy radiation dose (p <0.001) were greater in the standard glove group. There was no significant difference in surgeon hand exposure at the right (p = 0.143) or left hand (p = 0.608). Leaded gloves were associated with a significant increase in patient collar radiation at DDE (p = 0.002), LDE (p = 0.009), and SDE (p = 0.009).

In this pilot study, leaded glove use was associated with a significant and consistent increase in patient collar radiation across all measurement depths. The non-significant reduction in surgeon hand exposure should be interpreted cautiously given limited statistical power. These findings do not support routine leaded glove use during PCNL, and adequately powered studies are needed to confirm these findings and identify optimal radiation protection strategies.