Ultrasonographic Guidance versus Fluoroscopic Guidance for Renal Access in Percutaneous Nephrolithotomy (PCNL): A Comparative Study
Guiding access of percutaneous nephrolithotomy is essential in acquiring better surgical outcomes and preventing serious postoperative complications.
To assess the safety and efficacy of ultrasonographic guidance vs. fluoroscopic guidance for renal access in percutaneous nephrolithotomy (PCNL) focusing on the success rate of renal access, stone-free rate, operating time, duration of hospitalization, and major complications after the procedure.
PATIENTS AND METHODS:
A Prospective comparative study conducted in Shahid-Ghazi Hariri Surgical Specialties Hospital and Nursing Home Hospital in Baghdad Medical city. The duration of study was through the period from 1st of October, 2016 to 1st of October, 2018 on convenient sample of 70 patients with renal stones underwent percutaneous nephrolithotomy. The selected patients were categorized into two groups were undergoing percutaneous nephrolithotomy ;(35 patients guided with ultrasound) and (35 patients guided with fluoroscopy), they compared mainly by stone free rate, and secondarily by access time, operative time and post operative complication. S. T. O. N. E. score use to determine the charecter of the stone.
For patients with low S.T.O.N.E score no difference was found regarding stone free rate between ultrasonographic guidance and fluoroscopic guidance percutaneous nephrolithotomy (p value 0.1). For patients with high S.T.O.N.E score fluoroscopic guidance percutaneous nephrolithotomy achieve higher stone free rate ( p value 0.04) . No significant difference was found between the two groups regarding hemoglobin decline, blood transfusion, operative time and hospitalization.
Percutaneous nephrolithotomy under ultrasound guide is safe and effective as fluoroscopic guidance for patients with low S. T. O. N. E. score. Fluoroscopic guidance is more effective for patients with high S. T. O. N. E score.