Abstract
PurposeTo investigate the puncture accuracy and feasibility of contrast-enhanced ultrasound (CEUS) guided percutaneous nephrolithotomy (PCNL) in flank position for patients with no apparent hydronephrosis.MethodsBetween May 2018 and June 2020, 72 kidney stone patients with no or mild hydronephrosis were randomized into two groups: a CEUS-guided PCNL group and a conventional ultrasound (US)-guided group. Patients’ demographics and perioperative outcomes were compared, including the success rate of puncture via calyceal fornix, the success rate of a single-needle puncture, puncture time, operative time, postoperative hemoglobin loss, stone-free rate, incidence of complications and postoperative stay.ResultsThe success rate of puncture via calyceal fornix for CEUS-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002). Patients performed with CEUS-guided PCNL required shorter renal puncture time than those guided with conventional US (36.5 s vs. 61.0 s, p < 0.001). The median postoperative hemoglobin loss in the CEUS-guided group was significantly lower than that in conventional US-guided group (2.5 vs. 14.5 g/L, p < 0.01). There was no statistically significant difference in the success rate of a single-needle puncture, operative time, stone-free rate, incidence of complications and postoperative stay between the two groups.ConclusionCEUS guidance facilitates identification of the renal calyx fornix, and benefits more precise renal puncture and less hemoglobin loss in PCNL. CEUS-guided PCNL in flank position is a feasible approach to the treatment of kidney stone patients with no apparent hydronephrosis.Trial registration number: ChiCTR1800015417.
Highlights
Percutaneous nephrolithotomy (PCNL) is recommended as the standard procedure for upper urinary tract stones larger than 2 cm [1]
The success rate of puncture via calyceal fornix for contrast-enhanced ultrasound (CEUS)-guided group was significantly higher than that for conventional US-guided group (86.1 vs. 47.2%, p = 0.002, Supplementary table 2)
The present study demonstrated that CEUS-guided PCNL in flank position is feasible and safe for kidney stone patients with no apparent hydronephrosis
Summary
Percutaneous nephrolithotomy (PCNL) is recommended as the standard procedure for upper urinary tract stones larger than 2 cm [1]. Despite of the high stone clearance rate and many refinements of PCNL, there are still concerns regarding the potential risk of severe complications, including surrounding organ injury, bleeding requiring transfusion or embolization, or even death [2]. Puncture correctness was found to be the only significant factor related to severe bleeding requiring angioembolization after PCNL [3]. Precise renal puncture is a critical step in PCNL procedure. Fluoroscopic guidance, traditionally used for renal access, allows accurate identification of the targeted calyx for puncture. The main disadvantage of fluoroscopic guidance is lack
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