Percutaneous nephrolithotomy (PCNL) : Ultrasound guided puncture.

Abstract

Objective : To access the safety and efficacy of percutaneous nephrolithotomy (PCNL) by using ultrasound guide alone for caliceal puncture and dilating tract in lateral and prone position

Patients and methods : A prospective studied of 41 renal units from 39 patients (18-83 years old,M : F = 26 :13) who underwent PCNL by single surgeon from December 2004 to June 2005. There were 16 staghorn calculi, 11 multiple, 10 single and 4 upper UC.The average stone surface area was 825 mm2 . The PCNL was done in single stage under Ultrasound guided puncture for control depth and direction till
28Fr amplatz was inserted. Most PCNL was done in lateral position except 2 patients in prone position for bilateral PCNL. Ultrasonic lithotripsy was done.Fluoroscopy was used in some difficult cases to clear residual stones.

Result : Ultrasound guided puncture and tract access were successfully done in all cases. Average ultrasound time was 17 minutes. Stone clearance rate was 92.6 percent. Blood transfusion rate was 19.5 percent, mostly from staghorn RC.Fluoroscopy was used for removal of residual stones in 26 of 41 renal units,average fluoroscopic time was 1 minute and 42 seconds. Though there were 25 from 47 tracts done via supracostal puncture,there was no thoracic complication.Twenty-six tracts were done at mid or anterior axillary line without liver, spleen or colon injury. There was 1 case of transperitoneal puncture which required
subsequent JJ insertion. There was also 1 case of lacunar infarction with cranial nerve 12th palsy.

Conclusion : PCNL under ultrasound guide alone is safe and effective for varying stone sizes. Most of single stone can be done without radiation exposure at all.