Study The Efficacy of Ultrasound-Guided Access during Percutaneous Nephrolithotomy

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourologic procedure for treatment of large renal stones. Our aim in this study is to assess role of using ultrasound guided renal access during PCNL in minimizing exposure of both patients and medical personnel to ionizing. Methods: This Prospective, non-randomized clinical trial was conducted on 40 patients with
unilateral renal stones with stone burden 20 to 30 mm with moderate to marked backpressure and planned to undergo PCNL admitted to Urology Department Faculty of Medicine Tanta University. All patients were subjected to history talking, clinical examination, routine laboratory and radiological investigations including pelvic-abdominal ultrasound, KUB and non-contrast pelvi-abdominal CT. Results: The balloon dilation group was divided into two subgroups based on whether the dilation was successful on the first attempt. The success rate on the first attempt was 90%. Success rate was significantly higher with balloon than metal dilators and the latter was higher than Teflon dilators. Mean total operative time was statistically significant higher in failed than successful group. (P value=0.021). Fluoroscopic screening time was significantly higher in the failed group than successful group (P value=0.037). Conclusions: US PCNL can be used safely and effectively to treat patients with unilateral renal stones with stone burden 20 to 30 mm providing the advantages of less radiation exposure, no adjacent organ injury, and high success (90%) and low complication rates.