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3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy

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Abstract

Purpose

To provide a comprehensive analysis about safety and efficacy of fluoroscopy-free total ultrasound-guided percutaneous nephrolithotomy (TUPN) versus ultrasound with fluoroscopy-guided percutaneous nephrolithotomy (UFPN).

Patients and methods

3-dimensional ultrasound-guided PCNL was retrospectively analyzed in 377 patients from 2015 to 2017. TUPN was performed in 185 patients and UFPN was finished in 192 patients. In TUPN group, the entire procedures of puncture and dilation were real-time monitored by three-dimensional ultrasound alone. Conversely, in UFPN group, the puncture was performed under the guidance of real-time ultrasound, while the dilation was monitored by fluoroscopy. Preoperative demographic data, intraoperative parameters and postoperative complications were compared.

Results

Groups were comparable in baseline characteristics. Fifty percent of patients were Guy’s score III–IV and over half of the patients were mild or none of hydronephrosis. All renal punctures were successfully performed. The primary successful rates of dilation were more than 95% in both groups (95.1% in TUPN and 95.8% in UFPN, p = 0.74). Two or more accesses were established in 33 patients (17.8%) in TUPN group and 25 patients (13%) in UFPN group (p = 0.20). Post-operative instant stone-free rates were 88.6% and 90.1%, TUPN versus UFPN, respectively, p = 0.65. Most of the complications were minor and there were no differences in Clavien–Dindo complications in both groups. Mean operating time and hospitalization were comparable.

Conclusions

Our findings show that fluoroscopy-free total ultrasound-guided PCNL represents an alternatively safe and efficient approach for the treatment of renal stones. Further study will be required to evaluate fluoroscopy-free TUPN in various clinical settings.

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Abbreviations

PCNL:

Percutaneous nephrolithotomy

SFR:

Stone-free rate

TUPN:

Total ultrasound-guided percutaneous nephrolithotomy

UFPN:

Ultrasound and fluoroscopy-guided percutaneous nephrolithotomy

References

  1. Türk C, Petřík A, Sarica K et al (2016) EAU guidelines on interventional treatment for urolithiasis. Eur Urol 69(3):475–482

    Article  PubMed  Google Scholar 

  2. Çıtamak B, Altan M, Bozacı AC et al (2016) percutaneous nephrolithotomy in children: 17 years of experience. J Urol 195(4 Pt 1):1082–1087

    Article  PubMed  Google Scholar 

  3. Ghani KR, Andonian S, Bultitude M et al (2016) Percutaneous nephrolithotomy: update, trends, and future directions. Eur Urol 70(2):382–396

    Article  PubMed  Google Scholar 

  4. Kallidonis P, Kalogeropoulou C, Kyriazis I et al (2017) Percutaneous nephrolithotomy puncture and tract dilation: evidence on the safety of approaches to the infundibulum of the middle renal calyx. Urology 107:43–48

    Article  PubMed  Google Scholar 

  5. Blair B, Huang G, Arnold D et al (2013) Reduced fluoroscopy protocol for percutaneous nephrostolithotomy: feasibility, outcomes and effects on fluoroscopy time. J Urol 190(6):2112–2116

    Article  PubMed  Google Scholar 

  6. Chen TT, Wang C, Ferrandino MN et al (2015) Radiation exposure during the evaluation and management of nephrolithiasis. J Urol 194(4):878–885

    Article  PubMed  Google Scholar 

  7. Mancini JG, Raymundo EM, Lipkin M et al (2010) Factors affecting patient radiation exposure during percutaneous nephrolithotomy. J Urol 184(6):2373–2377

    Article  PubMed  Google Scholar 

  8. 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(4):612–618

    Article  PubMed  Google Scholar 

  9. Chau HL, Chan HC, Li TB, Cheung MH, Lam KM, So HS (2016) An innovative free-hand puncture technique to reduce radiation in percutaneous nephrolithotomy using ultrasound with navigation system under magnetic field: a single-center experience in Hong Kong. J Endourol 30(2):160–164

    Article  PubMed  Google Scholar 

  10. Chu C, Masic S, Usawachintachit M et al (2016) Ultrasound-guided renal access for percutaneous nephrolithotomy: a description of three novel ultrasound-guided needle techniques. J Endourol 30(2):153–158

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yan S, Xiang F, Yongsheng S (2013) Percutaneous nephrolithotomy guided solely by ultrasonography: a 5-year study of %3e 700 cases. BJU Int 112(7):965–971

    PubMed  Google Scholar 

  12. Yu W, Rao T, Li X et al (2017) The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills. Int Urol Nephrol 49(3):419–424

    Article  PubMed  Google Scholar 

  13. Li X, Long Q, Chen X, He D, He H (2017) Assessment of the SonixGPS system for its application in real-time ultrasonography navigation-guided percutaneous nephrolithotomy for the treatment of complex kidney stones. Urolithiasis 45(2):221–227

    Article  CAS  PubMed  Google Scholar 

  14. Inanloo SH, Yahyazadeh SR, Rashidi S et al (2018) Feasibility and safety of ultrasonography guidance and flank position during percutaneous nephrolithotomy. J Urol 200(1):195–201

    Article  PubMed  Google Scholar 

  15. Usawachintachit M, Tzou DT, Hu W, Li J, Chi T (2017) X-ray-free ultrasound-guided percutaneous nephrolithotomy: how to select the right patient? Urology 100:38–44

    Article  PubMed  Google Scholar 

  16. Ding X, Wu W, Hou Y, Wang C, Wang Y (2018) Application of prepuncture on the double-tract percutaneous nephrolithotomy under ultrasound guidance for renal staghorn calculi: first experience. Urology 114:56–59

    Article  PubMed  Google Scholar 

  17. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  18. Sarica K (2017) Renal access during percutaneous nephrolithotomy: increasing value of ultrasonographic guidance for a safer and successful procedure. BJU Int 119(4):509–510

    Article  PubMed  Google Scholar 

  19. Hudnall M, Usawachintachit M, Metzler I et al (2017) Ultrasound guidance reduces percutaneous nephrolithotomy cost compared to fluoroscopy. Urology 103:52–58

    Article  PubMed  Google Scholar 

  20. Liu Q, Zhou L, Cai X, Jin T, Wang K (2017) Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 45(5):481–487

    Article  PubMed  Google Scholar 

  21. Srivastava A, Singh S, Dhayal IR, Rai P (2017) A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy. World J Urol 35(5):803–807

    Article  PubMed  Google Scholar 

  22. Usawachintachit M, Masic S, Allen IE, Li J, Chi T (2016) Adopting ultrasound guidance for prone percutaneous nephrolithotomy: evaluating the learning curve for the experienced surgeon. J Endourol 30:856–863

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gamal WM, Hussein M, Aldahshoury M et al (2011) Solo ultrasonography-guided percutanous nephrolithotomy for single stone pelvis. J Endourol 25(4):593–596

    Article  PubMed  Google Scholar 

  24. Seitz C, Desai M, Häcker A et al (2012) Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol 61(1):146–158

    Article  PubMed  Google Scholar 

  25. Kallidonis P, Panagopoulos V, Kyriazis I, Liatsikos E (2016) Complications of percutaneous nephrolithotomy: classification, management, and prevention. Curr Opin Urol 26(1):88–94

    Article  PubMed  Google Scholar 

  26. Kamphuis GM, Baard J, Westendarp M, de la Rosette JJ (2015) Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 33(2):223–233

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, First Hospital of Jilin University, Changchun, China

    Xiaobo Ding

  2. Department of Urology, First Hospital of Jilin University, Changchun, 130021, China

    Yun Hao, Yatao Jia, Yuchuan Hou, Chunxi Wang & Yanbo Wang

Authors
  1. Xiaobo Ding
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  2. Yun Hao
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  3. Yatao Jia
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  4. Yuchuan Hou
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  5. Chunxi Wang
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  6. Yanbo Wang
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Contributions

CW, YW: project development. YH, YJ, HL, ST: data collection or management. XD, YH: data analysis. XD, YW: manuscript writing. CW, YW: manuscript editing.

Corresponding author

Correspondence to Yanbo Wang.

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The authors declare no conflict of interest.

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All procedures performed in studies involving human participants were obtained from the institutional Ethics committee of First Hospital of Jilin University, Changchun, China.

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Ding, X., Hao, Y., Jia, Y. et al. 3-dimensional ultrasound-guided percutaneous nephrolithotomy: total free versus partial fluoroscopy. World J Urol 38, 2295–2300 (2020). https://doi.org/10.1007/s00345-019-03007-y

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  • DOI: https://doi.org/10.1007/s00345-019-03007-y

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