1680 ENDOSCOPIC-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A TECHNIQUE TO REDUCE RADIATION DOSAGE

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (II)1 Apr 20131680 ENDOSCOPIC-GUIDED PERCUTANEOUS NEPHROLITHOTOMY: A TECHNIQUE TO REDUCE RADIATION DOSAGE Andrea G. Lantz, Padraic O'Malley, Michael Ordon, and Jason Y. Lee Andrea G. LantzAndrea G. Lantz Toronto, Canada More articles by this author , Padraic O'MalleyPadraic O'Malley Toronto, Canada More articles by this author , Michael OrdonMichael Ordon Toronto, Canada More articles by this author , and Jason Y. LeeJason Y. Lee Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3042AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent literature has highlighted the potential oncologic consequences of excessive diagnostic radiation exposure. Diagnosis and treatment of kidney stones often exposes patients to high levels of radiation. Percutaneous nephrolithotomy (PCNL) in particular, can be associated with large amounts of radiation exposure. Endoscopic-guided PCNL (ePCNL) is a relatively rare approach to PCNL that may have advantages in this regard, compared to standard PCNL techniques. The purpose of this study is to determine the radiation exposure (fluoroscopy time [FT] and effective dose of radiation [EDR]) related to ePCNL and to compare it to the published literature for standard PCNL techniques. METHODS A retrospective review of all ePCNL procedures performed at our institution from Nov 2011 to Oct 2012 was conducted. All cases were performed by a single surgeon using under-table, C-arm fluoroscopy. Total FT and radiation dosage for each case was recorded and the EDR was calculated using standard conversion tables. Pearson correlation was used to assess for covariates significantly correlated with longer FT and higher EDR. RESULTS A total of 29 ePCNL cases were reviewed. Mean patient age was 64 ±13 yrs, 45% were male, and mean BMI was 30 ±6.5 kg/m2. Mean stone size was 3.3 × 2.0 cm with 52% and 11% of stones being partial and complete staghorn calculi, respectively. Almost half (49%) of cases utilized an upper pole puncture, with 61% supracostal punctures; only one patient required 2 tracts. Mean FT was 4.2 ±3.6 mins and mean EDR was 2.8 ±2.4 mSv. Stone-free rate was 82% and 11% required ancillary procedures. Overall complication rate was 31% with the majority (7/9) being Clavien-Dindo grade 1-2. Longer FT correlated with increased stone size (p=0.002) and the need for ancillary procedures (p=0.005) while higher EDR correlated with increased skin-to-stone distance (SSD; p=0.013). Higher BMI did not correlate with FT, EDR or operative time. CONCLUSIONS This preliminary, single-centre review demonstrates that the ePCNL technique may be associated with a reduction in radiation dosage when compared to standard PCNL techniques (Table 1), with comparable stone-free and complication rates. Comparative Radiation Doses and Fluoroscopy Times for PCNL Author (year) Radiation Dose Fluoroscopy Time (min) Comments Current study 2.8 mSv 4.2 EDR Ritter (2012) NR 7.3 Inexperienced NR 6.2 Experienced endourologist Lipkin (2011) 4.45 mSv 6.9 EDR, air pyelogram group 7.67 mSv 10.7 EDR, contrast pyelogram group Jamal (2011) 43.3 mGy NR IR access + intraoperative c-arm data Mancini (2010) 8.66 mSv NR EDR Tepeler (2009) NR 10.19 EDR = effective dose of radiation, IR = interventional radiology, NR = not reported © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e691 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea G. Lantz Toronto, Canada More articles by this author Padraic O'Malley Toronto, Canada More articles by this author Michael Ordon Toronto, Canada More articles by this author Jason Y. Lee Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...