Percutaneous nephrolithotomy in horseshoe kidney: comparing ultrasound-guided access in flank position with conventional fluoroscopic-guided in prone position.

Abstract

We conducted this study to compare radiation-free US-guided percutaneous nephrolithotomy (PNL) in the flank position with conventional PNL in the prone position for the treatment of renal stones in patients with horseshoe kidneys. In a retrospective study, 14 HSK patients that were treated with conventional fluoroscopy-guided PNL in the prone position (group A) were compared with twenty-four HSK patients that were treated US-guided PNL in the flank position (group B). Data on baseline characteristics, percentage of successful entries, stone-free rate, duration of admission and complication rate were obtained from data registry. The average duration of the operation was 57.6min in group B, which was statistically less than group A with 65.9min (P = 0.001). Access time varied from 10 to 32.4min (mean = 17.1min) in group A and 5-29.5min (mean = 10.9min) in group B (P < 0.001). Access length had a significant relation to the surgery method so PNL with US-guided had less access length (P = 0.002). There was no significant relationship between the surgery guide and the residual stone rate (P = 0.6). Hemoglobin decrease (P = 0.5), hospitalization duration (P = 0.5) and need for blood transfusion (P value = 0.6) were not statistically different between the two groups. PNL with US guidance in flank position is a safe and effective technique in HSK patients and is associated with fewer complications than the traditional approach as well as reduced operating time, radiation exposure, and its complications.