Multislice computed tomography vs. intravenous urography for planning supine percutaneous nephrolithotomy: A randomised clinical trial

Abstract

ObjectiveTo compare the outcome of treatment planning using multislice computed tomography (CT) or intravenous urography (IVU) for supine percutaneous nephrolithotomy (PCNL). Patients and methodsThe study included 60 patients with renal stones, all treated by supine PCNL, between March 2011 and October 2012. The patients were divided randomly into two equal groups; in group 1 30 patients had the PCNL access planned based on IVU findings, and in group 2 the PCNL access was planned based on multislice CT images. All patients were suitable for PCNL, based on a plain abdominal film and ultrasonography, and with a body mass index of <30kg/m2. The exclusion criteria were renal anomalies and bleeding diathesis. All data from both groups for the mean time taken to gain percutaneous access, operative duration, fluoroscopic time, access difficulty, stone-free rate and intraoperative morbidity were collected and analysed statistically. ResultsThe mean (SD) time taken to gain percutaneous access was longer in group 1 than group 2, at 22.2 (1.76) vs. 13.1 (1.62) min (P<0.001), as were the operative duration, at 81.9 (14.9) vs. 58.8 (7.6) min (P<0.001), and fluoroscopic time, at 3.5 (1.7) vs. 2.2 (1.3) min (P=0.002). In group 1 there were four cases (13%) in which there were difficulties in establishing percutaneous access, while in group 2 there were none (P=0.003). There was intraoperative morbidity in three patients (10%) in group 1 and two (7%) in group 2. ConclusionMultislice CT is a safer, more accurate and noninvasive imaging technique than IVU for mapping the pelvicalyceal system. It saves time and is essential in choosing the optimal percutaneous access into the pelvicalyceal system for a safe and successful PCNL.