Efficacy of Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy in Combination with Fluoroscopy versus Fluoroscopy as a Single Imaging Modality

Abstract Background Renal stone is one of the most common renal diseases worldwide. There are several modalities for treatment of renal stone disease, one of these modalities is the use of percutaneous nephrolithatomy (PCNL) surgery which can be done either under fluoroscopic or ultrasound guidance which has significantly reduced x-ray exposure risk to medical personnel and patients. Objective To evaluate the efficacy of the ultrasound-guided PCNL in combination with fluoroscopy to minimize exposure time to radiation, risk of accidental injury to adjacent organs, blood loss and increased stone clearance rate versus usage of fluoroscopy as a single imaging modality in PCNL. Patients and Methods This prospective randomized comparative clinical trial study was conducted on 40 patients for the treatment of stone(s) located in the kidney more than 2 cm or refractory to shockwave therapy, patients were divided into 2 groups, 20 patients each; Group I: ultrasound-guided PCNL in combination with fluoroscopy and Group II: use of fluoroscopy as a single imaging modality, the study was carried on at Urology department, Faculty of medicine, Ain Shams University and Urology department, Theodor Bilharz Research Institute. Results As regard post operative complications in studied groups, in group I, there were 3 patients (15%) with post-operative fever versus 4 patients (20%) in group II. In group I, there was 1 patient (5%) with post-operative leakage versus 3 patients (15%) in group II. In group II, there was 1 patient (5%) with post-operative blood transfusion versus 0 patients (0%) in group I with no statistical difference. With respect to post-operative hospital stay and need for second operation between studied groups, there was a highly statistical significant (p-value < 0.001) increased post- operative hospital stay in group II (3.5 ± 1.05) when compared with group I (1.9 ± 0.9). While, as regard need for second operation and type of the operation, there were no statistical differences between the studied groups. But, there was high statistical significant difference (p-value < 0.001) decreased x-ray exposure time in group I (43.2 ± 11.3 sec) when compared to group II (314 ± 84.2 sec). Conclusion Combined ultrasonic and fluoroscopic guided PCNL had shorter x-ray exposure time. Combined ultrasonic and fluoroscopic guided PCNL had less Hb drop and intraoperative complications. However it still had longer surgery duration. Combined ultrasonic and fluoroscopic guided PCNL showed less postoperative pain and analgesic consumption. Combined ultrasonic and fluoroscopic guided PCNL had shorter hospital stay. Regarding the outcome and complications, in general, there is no statistical significant difference between these two groups.