Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial
Urology Journal,
Vol. 21 No. 03 (2024),
11 May 2024
,
Page 140-145
https://doi.org/10.22037/uj.v20i.7798
Abstract
Objective: Utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy
(PCNL) to minimize radiation exposure.
Methods: In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery
in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were
grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement.
The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and
nephroscope entrance, and the Clavien-Dindo score were collected.
Results: The mean age of all patients was 46.12 ± 11.28 (45.6 ± 11.2 in the total fluoroscopy group and 46.5 ±
11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant.
The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22 ± 10.73
vs. 23.05±8.94 seconds, (P-value = 0.001). Moreover, the difference in the distribution of Amplatz location on the
nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts
to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross
hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful.
Conclusion: It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of
X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and
postoperative detrimental events.
- Kidney stones
- Percutaneous nephrolithotomy
- Fluoroscopy
- Ultrasonography
How to Cite
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