A Randomized Controlled Trial of Ultrasound versus Fluoroscopic Guidance for Percutaneous Nephrolithotomy
Keywords:
Ultrasound, Fluoroscopic Guidance, Percutaneous NephrolithotomyAbstract
Objective: To compare the success rate of ultrasound (US) versus fluoroscopic guidance in entering the target calyx from a proper entry site and in the direction of renal pelvis during percutaneous nephrolithotomy (PCNL), and to determine their relative advantages and disadvantages.
Methods: The present randomized controlled study was conducted between May 2020 and March 2021. Just before PCNL, patients were randomly assigned to undergo either US guidance access (group A) or fluoroscopic guidance access (group B). A needle placed on the patient’s flank in the prone position was used to identify the preselected target. The needle was advanced through a needle holder and helped guide percutaneous tract dilation. Data on patient characteristics, tract length, tract access time, and the stone free rate were collected for analysis. Data were analyzed using t-test, chi-square test and Fisher’s exact test.
Results: There were a total of 40 patients in the trial with 20 patients in each group. There were no statistically significant differences between patients in groups A and B in terms of age, gender, ASA status, BMI, stone size and stone location. The average length of the access tract was 7.7 cm in group A and 7.6 cm. in group B (p = 0.672). The tract access time was 15 minutes in group A and 13 minutes in group B (p = 0.288). The frequencies of location of the access tract at the upper pole in groups A and B were 11 and 12, respectively (p = 0.252). The stone free rate was 45% (9/20) in group A and 55% (11/20) in group B (p = 0.853).
Conclusions: The present study showed that PCNL under US guidance had similar success as PCNL under fluoroscopic guidance. US can be used as an alternative to fluoroscopy in PCNL. The present randomized trial might help convince some endourologists to use US rather than fluoroscopy in their management of renal stones, in order to minimize exposure to ionizing radiation.
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