Pure Ultrasound with Two-Step Dilation vs. Combined Ultrasound-Fluoroscopy in Percutaneous Nephrolithotomy: Is Fluoroscopy Still Needed?

Objective: Fluoroscopy has been the most widely used guidance method for percutaneous nephrolithotomy (PCNL); however, radiation exposure is a significant concern. Recently, ultrasound has gained popularity, offering several advantages. The objective was to evaluate the safety and outcomes of the pure-ultrasound PCNL with a two-step tract dilation. Material and Methods: The authors retrospectively analyzed the data of patients from March 2019 to October 2023. In all patients, percutaneous renal access was ultrasound guided, and they were divided into 2 groups: Group 1, all steps of PCNL were performed under ultrasound guidance, and Group 2, tract dilation, confirmation of stone clearance, and exit strategy were done with fluoroscopy. Results: The authors included 100 patients, 60 in Group 1 and 40 in Group 2, with a mean body mass index of 30.8 kg/m2. Mean stone burden was 4,162 mm3, 53% were complex stones and 59% of the cases were without hydronephrosis in the targeted calyx. Fluoroscopy was absent in Group 1 and 20 (11.3-31.5) seconds in Group 2 (P < .001). Complications were present in 13% of the cases. Group 1 patients had a lower complication rate than those in Group 2 (10% and 17%, respectively, P = .27). The authors had a global stone-free rate of 79%, Group 1: 78.3% and Group 2: 80% (P = 1.0). Multivariate analysis revealed that the stone-free rate is associated with the total operative time (P = .002) and the number of tracts (P = .031). Conclusion: Pure ultrasound PCNL is a safe and effective technique, offering a similar stone-free rate compared to fluoroscopy and providing an alternative method to avoid radiation exposure during PCNL. Cite this article as: Pulido-Contreras E, Garcia-Padilla MA, Rios-Melgarejo C, Medrano-Sanchez J, Leon-Verdin MG, Sur RL. Pure ultrasound with two-step dilation vs. combined ultrasoundfluoroscopy in percutaneous nephrolithotomy: Is fluoroscopy still needed? Urol Res Pract. 2025;51(6):217-224.