Skip to main content
SpringerLink
Log in

Comparison of contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with nondilated collecting system: a randomized controlled trial

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To compare the safety, effectiveness, and feasibility of contrast-enhanced ultrasound (CEUS) versus conventional ultrasound-guided percutaneous nephrolithotomy (PCNL) in patients with nondilated collecting system.

Methods

Between July 2018 and July 2020, 160 kidney stone patients with nondilated collecting system planned for PCNL were randomly assigned into two groups, CEUS with retrograde ureteral contrast injection and conventional ultrasound with retrograde ureteral normal saline injection. Patient’s demographics, the success rate of puncture, success rate of a single-needle puncture, number of punctures, puncture time, perioperative outcomes, stone-free rate, and incidence of complications were compared.

Results

The success rate of a single-needle puncture for CEUS-guided PCNL was higher than that in the conventional ultrasound group (88.5% vs. 73.7%, p = 0.02). Patients performed with CEUS-guided PCNL required less needle passes (p = 0.02), shorter needle puncture time (p = 0.031), and shorter channel establishment time (p = 0.04) than those guided with conventional ultrasound. The postoperative hemoglobin decrease in the CEUS-guided PCNL group was less than that of the control group (p = 0.02). There was no significant difference in operating time, length of hospital stays, kidney function change, and complications between the two groups (p > 0.05). The 1-month stone-free rate was 94.9% in the CEUS group and 90.8% in the control group (p > 0.05).

Conclusions

Compared with conventional ultrasound, CEUS-guided PCNL may facilitate ultrasound-guided PCNL for patients without hydronephrosis, and benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop.

Trial registration

Chinese Clinical Trial Registry: ChiCTR1800016981

Key Points

• Compared with conventional ultrasound, CEUS-guided PCNL is a safe and efficacious procedure for kidney stone patients with nondilated collecting system.

• Compared with conventional ultrasound, CEUS-guided PCNL benefited with a higher success rate of a single-needle puncture, less needle passes, shorter puncture time, and lower postoperative Hb drop.

• CEUS-guided PCNL associated with the more accurate needle puncture and acceptable complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

CDFI:

Color Doppler flow imaging

CEUS:

Contrast-enhanced ultrasound

CT:

Computerized tomography

Hb:

Hemoglobin

LOS:

Length of hospital stay

No.:

Number

PCN:

Percutaneous nephrostomy

PCNL:

Percutaneous nephrolithotomy

SFR:

Stone-free rate

References

  1. Ghani KR, Andonian S, Bultitude M et al (2016) Percutaneous nephrolithotomy: update, trends, and future directions. Eur Urol 70:382–396

    Article  Google Scholar 

  2. Andonian S, Scoffone CM, Louie MK et al (2013) Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 27:24–28

    Article  Google Scholar 

  3. Basiri A, Mohammadi Sichani M, Hosseini SR et al (2010) X-ray-free percutaneous nephrolithotomy in supine position with ultrasound guidance. World J Urol 28:239–244

    Article  Google Scholar 

  4. Agarwal M, Agrawal MS, Jaiswal A, Kumar D, Yadav H, Lavania P (2011) Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU Int 108:1346–1349

    Article  Google Scholar 

  5. Zhu W, Li J, Yuan J et al (2017) A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy. BJU Int 119:612–618

    Article  Google Scholar 

  6. Karami H, Rezaei A, Mohammadhosseini M, Javanmard B, Mazloomfard M, Lotfi B (2010) Ultrasonography-guided percutaneous nephrolithotomy in the flank position versus fluoroscopy-guided percutaneous nephrolithotomy in the prone position: a comparative study. J Endourol 24:1357–1361

    Article  Google Scholar 

  7. Wang K, Zhang P, Xu X, Fan M (2015) Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a meta-analysis. Urol Int 95:15–25

    Article  Google Scholar 

  8. Tzeng BC, Wang CJ, Huang SW, Chang CH (2011) Doppler ultrasound-guided percutaneous nephrolithotomy: a prospective randomized study. Urology 78:535–539

    Article  Google Scholar 

  9. Pabon-Ramos WM, Dariushnia SR, Walker TG et al (2016) Quality improvement guidelines for percutaneous nephrostomy. J Vasc Interv Radiol 27:410–414

    Article  Google Scholar 

  10. Yagci C, Ustuner E, Atman ED, Baltaci S, Uzun C, Akyar S (2013) Diuretic agent and normal saline infusion technique for ultrasound-guided percutaneous nephrostomies in nondilated pelvicaliceal systems. Cardiovasc Intervent Radiol 36:492–497

    Article  Google Scholar 

  11. Correas JM, Anglicheau D, Joly D, Gennisson JL, Tanter M, Helenon O (2016) Ultrasound-based imaging methods of the kidney-recent developments. Kidney Int 90:1199–1210

    Article  Google Scholar 

  12. Luyao Z, Xiaoyan X, Huixiong X, Zuo-Feng X, Guang-Jian L, Ming-de L (2012) Percutaneous ultrasound-guided cholangiography using microbubbles to evaluate the dilated biliary tract: initial experience. Eur Radiol 22:371–378

    Article  Google Scholar 

  13. Xu EJ, Zheng RQ, Su ZZ, Li K, Ren J, Guo HY (2012) Intra-biliary contrast-enhanced ultrasound for evaluating biliary obstruction during percutaneous transhepatic biliary drainage: a preliminary study. Eur J Radiol 81:3846–3850

    Article  Google Scholar 

  14. Cui XW, Ignee A, Maros T, Straub B, Wen JG, Dietrich CF (2016) Feasibility and usefulness of intra-cavitary contrast-enhanced ultrasound in percutaneous nephrostomy. Ultrasound Med Biol 42:2180–2188

    Article  Google Scholar 

  15. Liu BX, Huang GL, Xie XH, Zhuang BW, Xie XY, Lu MD (2017) Contrast-enhanced US-assisted percutaneous nephrostomy: a technique to increase success rate for patients with nondilated renal collecting system. Radiology 285:293–301

    Article  Google Scholar 

  16. Chi T, Usawachintachit M, Weinstein S et al (2017) Contrast enhanced ultrasound as a radiation-free alternative to fluoroscopic nephrostogram for evaluating ureteral patency. J Urol 198:1367–1373

    Article  Google Scholar 

  17. Chi T, Usawachintachit M, Mongan J et al (2017) Feasibility of antegrade contrast-enhanced US nephrostograms to evaluate ureteral patency. Radiology 283:273–279

    Article  Google Scholar 

  18. Usawachintachit M, Tzou DT, Mongan J, Taguchi K, Weinstein S, Chi T (2017) Feasibility of retrograde ureteral contrast injection to guide ultrasonographic percutaneous renal access in the nondilated collecting system. J Endourol 31:129–134

    Article  Google Scholar 

  19. de la Rosette JJ, Zuazu JR, Tsakiris P et al (2008) Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 180:2489–2493

    Article  Google Scholar 

  20. Egilmez H, Oztoprak I, Atalar M et al (2007) The place of computed tomography as a guidance modality in percutaneous nephrostomy: analysis of a 10-year single-center experience. Acta Radiol 48:806–813

    Article  CAS  Google Scholar 

  21. Barbaric ZL, Hall T, Cochran ST et al (1997) Percutaneous nephrostomy: placement under CT and fluoroscopy guidance. AJR Am J Roentgenol 169:151–155

    Article  CAS  Google Scholar 

  22. Sommer CM, Huber J, Radeleff BA et al (2011) Combined CT- and fluoroscopy-guided nephrostomy in patients with non-obstructive uropathy due to urine leaks in cases of failed ultrasound-guided procedures. Eur J Radiol 80:686–691

    Article  CAS  Google Scholar 

  23. Lodh B, Gupta S, Singh AK, Sinam RS (2014) Ultrasound guided direct percutaneous nephrostomy (PCN) tube placement: stepwise report of a new technique with its safety and efficacy evaluation. J Clin Diagn Res 8:84–87

    PubMed  PubMed Central  Google Scholar 

  24. Rizvi SAH, Hussain M, Askari SH, Hashmi A, Lal M, Zafar MN (2017) Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients. BJU Int 120:702–709

    Article  Google Scholar 

  25. Li JX, Tian XQ, Niu YN, Zhang X, Kang N (2006) Percutaneous nephrolithotripsy with pneumatic and ultrasonic power under B-type ultrasound guidance for treatment of renal calculi in non-dilated collecting system. Zhonghua Wai Ke Za Zhi 44:386–388

    PubMed  Google Scholar 

  26. Chen D, Jiang C, Liang X et al (2019) Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones. BJU Int 123:1041–1047

    Article  CAS  Google Scholar 

  27. Korets R, Graversen JA, Kates M, Mues AC, Gupta M (2011) Post-percutaneous nephrolithotomy systemic inflammatory response: a prospective analysis of preoperative urine, renal pelvic urine and stone cultures. J Urol 186:1899–1903

    Article  Google Scholar 

  28. Zhao Z, Cui Z, Zeng T, Wan SP, Zeng G (2016) Comparison of 1-stage with 2-stage multiple-tracts mini-percutaneous nephrolithotomy for the treatment of staghorn stones: a matched cohorts analysis. Urology 87:46–51

    Article  Google Scholar 

  29. Akman T, Binbay M, Kezer C et al (2012) Factors affecting kidney function and stone recurrence rate after percutaneous nephrolithotomy for staghorn calculi: outcomes of a long-term followup. J Urol 187:1656–1661

    Article  Google Scholar 

  30. Omar M, Noble M, Sivalingam S et al (2016) Systemic inflammatory response syndrome after percutaneous nephrolithotomy: a randomized single-blind clinical trial evaluating the impact of irrigation pressure. J Urol 196:109–114

    Article  Google Scholar 

Download references

Acknowledgements

This project was supported by the National Natural Science Foundation of China (No. 81900645). We thank the patients who participated in this study.

Funding

This study has received funding from the National Natural Science Foundation of China (No. 81900645).

Author information

Author notes

  1. Ding Xia and Ejun Peng contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Ding Xia, Ejun Peng, Xiaoqi Yang, Hailang Liu, Yonghua Tong, Xinguang Wang, Hua Xu, Zhangqun Ye, Kun Tang & Zhiqiang Chen

  2. Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Yang Yu

  3. Hubei Institute of Urology, Wuhan, 430030, China

    Kun Tang & Zhiqiang Chen

Authors
  1. Ding Xia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ejun Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yang Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaoqi Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hailang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yonghua Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xinguang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hua Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhangqun Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kun Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhiqiang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Kun Tang or Zhiqiang Chen.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Kun Tang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• randomized controlled trial

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xia, D., Peng, E., Yu, Y. et al. Comparison of contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with nondilated collecting system: a randomized controlled trial. Eur Radiol 31, 6736–6746 (2021). https://doi.org/10.1007/s00330-021-07804-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-07804-1

Keywords

Search

Navigation