Feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis

Abstract

Objective To investigate the feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis. Methods From April 2016 to July 2016, 5 patients with renal calculi complicated with hydronephrosis were selected. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of optison via an ipsilateral ureteral catheter. Results Five patients (four males and one female) with renal stones underwent percutaneous nephrolithotomy (PCNL) with retrograde ultrasound contrast injection during the study period. Mean body mass index was(28.3±5.6)kg/m2 and mean stone size was(24.5±12.0)mm. Under B-mode ultrasound, all patients demonstrated non-dilated renal collecting systems that appeared as hyperechoic areas, where it was difficult to identify a target calix for puncture.Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under B-mode ultrasound. Renal puncture was then performed effectively in all cases with a mean puncture time of(55.4±44.8)seconds. All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred. Conclusions Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale stu-dies comparing its use to standard ultrasound-guided technique will be required to validate this concept. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Lithotripsy; Urography