PD11-05 CONTRAST-ENHANCED ULTRASOUND AS A REPLACEMENT FOR FLUOROSCOPIC NEPHROSTOGRAM FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 2017PD11-05 CONTRAST-ENHANCED ULTRASOUND AS A REPLACEMENT FOR FLUOROSCOPIC NEPHROSTOGRAM FOLLOWING PERCUTANEOUS NEPHROLITHOTOMY Thomas Chi, Manint Usawachintachit, David Tzou, Helena Chang, Benjamin Sherer, Marshall Stoller, Stefanie Weinstein, and John Mongan Thomas ChiThomas Chi More articles by this author , Manint UsawachintachitManint Usawachintachit More articles by this author , David TzouDavid Tzou More articles by this author , Helena ChangHelena Chang More articles by this author , Benjamin ShererBenjamin Sherer More articles by this author , Marshall StollerMarshall Stoller More articles by this author , Stefanie WeinsteinStefanie Weinstein More articles by this author , and John MonganJohn Mongan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.581AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fluoroscopic nephrostogram is commonly used to evaluate ureteral patency after percutaneous nephrolithotomy. However, it can incur a significant exposure to ionizing radiation. We have reported feasibility and safety for contrast-enhanced ultrasound nephrostogram with collecting system microbubble contrast injection to obviate the need for radiation exposure. In this study, we compared contrast-enhanced ultrasound to fluoroscopic nephrostogram in evaluating ureteral patency after percutaneous nephrolithotomy. METHODS After obtaining institutional review board approval for off-label use of an ultrasound contrast agent, consecutive patients with kidney stones who underwent percutaneous nephrolithotomy at our medical center were eligible for enrollment in this prospective cohort non-inferiority study. Postoperative day 1 after surgery, contrast-enhanced ultrasound and fluoroscopic nephrostogram were performed within 2 hours of one other for each patient to identify ureteral patency, the primary outcome for this study. Results from both imaging studies were reviewed in a blinded fashion by two experienced radiologists and compared. RESULTS Eighty-six imaging studies were performed in 76 patients during the study period from September 2015 to September 2016. Females (58.3%) predominated males (41.7%) with a mean age of 51.2±16.1 years and a mean body mass index of 29.6±8.4 kg/m2. Four studies were excluded due to technical factors preventing imaging interpretation. For the remaining 82 studies, 66 (80.5%) demonstrated concordance for detecting ureteral patency between the two imaging techniques. Within the 16 (19.5%) discordant studies,15 showed antegrade urine flow on contrast-enhanced ultrasound but not on fluoroscopic nephrostogram, and one antegrade flow on fluoroscopic nephrostogram but not on ultrasound. For discordant studies, 97.5% of tubes were managed according to ultrasound results. No adverse events were noted related to any contrast-enhanced ultrasound studies. While contrast-enhanced ultrasound utilized no ionizing radiation, fluoroscopic nephrostograms provided a mean radiation exposure dose of 13.1±17.5 mGycm2 for patients. CONCLUSIONS Contrast-enhanced ultrasound can be used to perform a nephrostogram with ultrasound contrast administered via a nephrostomy tube. This novel imaging technique is non-inferior to fluoroscopic nephrostogram, safe for patients, and devoid of radiation exposure in evaluating ureteral patency following percutaneous nephrolithotomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e207-e208 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Thomas Chi More articles by this author Manint Usawachintachit More articles by this author David Tzou More articles by this author Helena Chang More articles by this author Benjamin Sherer More articles by this author Marshall Stoller More articles by this author Stefanie Weinstein More articles by this author John Mongan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...