Ultrasonography-Guided Percutaneous Nephrolithotomy

Abstract

To evaluate the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL). Between August 2003 and December 2007, 47 patients were treated, 29 men and 18 women, with a mean age of 33.4 years (range 21-67 yrs) and a mean stone size of 31.5 mm (range 24-46 mm). All stones were located in the renal pelvis with mild to moderate hydronephrosis seen on intravenous urography. A ureteral stent was inserted cystoscopically, and saline was injected for more localization of the pelvicaliceal system (PCS), if needed. Puncture of the PCS was performed with an 18-gauge nephrostomy needle through the lower pole calyx, and all the stages, including dilatation, were performed under ultrasonography guidance. Thirty-nine patients were stone free in the kidneys, ureters, and bladder the day after the operation. Five patients had multiple fragments that measured about 4 to 5 mm, which passed in 4 weeks (total stone-free rate: 93.61%); failure occurred in two patients, and fluoroscopy was needed; two patients who had residual fragments that measured 10 and 12 mm underwent shockwave lithotripsy; and in one patient, a fragment that measured 7 to 8 mm migrated into the ureter--it fragmented and was removed with a ureteroscope 2 days after the operation. PCNL using sonography is a good alternative to the fluoroscopic method. It is performed without radiation exposure to the surgeon and patient; however, more experience is needed.