Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review.

Abstract

Nowadays percutaneous nephrolithotomy (PCNL) is the standard of care for renal staghorn calculus or large (>20 mm)pelvic or caliceal stones, as well as for the failure of other treatment options.This review aims to evaluate the contemporary use of ultrasound imaging in PCNL, by comparing it to conventional fluoroscopy,reviewing data regarding the complication and success rate of nephrostomy tract creation and stone free rate (SFR), aswell as data concerning the learning curve for these procedures and cost indicators.The evidence acquired shows that the ultrasound guided access (USGA) is a comparable method with the classic fluoroscopicguided access (FGA), with a similar safety profile, with a significant reduction in radiation exposure, up to radiationfree complete PCNL. USGA PCNL seems to lead to decreased bleeding and need for transfusion, especially when the Dopplermode is used, and also to a slightly higher SFR than conventional FGA PCNL. USGA PCNL reduces the overall costs of theprocedure by about 30% and can be safely learnt and performed by urologists. For an experienced endourologist, familiar withFGA PCNL, the learning curve for shifting to USGA PCNL is of approximately 20 procedures.