Complete Ultrasound-Guided Supine Percutaneous Nephrolithotomy: A Single-Center Study in a Tertiary Care Hospital in Eastern India

Objective: Percutaneous nephrolithotomy (PCNL) has been the gold standard for managing large renal calculi since its introduction. Concurrently, ultrasound guidance has emerged as a viable alternative to fluoroscopy, eliminating radiation exposure while providing real-time visualization of renal anatomy and adjacent structures. Aim of the study is to evaluate the safety, efficacy, and outcomes of total ultrasound-guided supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Methods: This prospective observational study was conducted at a tertiary care hospital for a period of 18 months. Fifty patients included in the study with renal stones with size >1.5cm or symptomatic stones who underwent supine PCNL with complete ultrasound guidance using a 5-2MHz convex probe. Primary outcome was stone-free rate. Secondary outcomes included operative parameters, complications, and auxiliary procedure requirements. Results: Mean patient age was 47.2±14.6 years with 60% male predominance. Mean stone size was 1.8±0.7cm. Overall stone-free rate was 72% (36/50 patients). Stones ≤2cm achieved significantly higher clearance rates compared to >2cm stones (81.25% vs 55.56%, p=0.041). Guy's Stone Score was the strongest predictor of success (GSS-1: 85.71%, GSS-2: 50%, GSS-3: 28.57%, p=0.002). Mean operative time was 127.8±42.5 minutes. Complications occurred in 44% of patients (Grade I-II: 40%, Grade III-IVA: 4%). Auxiliary procedures were required in 30% of cases. Conclusions: Total ultrasound-guided supine PCNL is a safe and effective radiation-free technique with acceptable stone clearance rates. Guy's Stone Score and stone size are significant predictors of success.