X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical control

Abstract

PurposeTo compare the outcomes and complications of supine X-ray-free ultrasound-guided percutaneous nephrolithotomy (XG-PCNL) with fluoroscopy-guided (FG)-PCNL in both prone and supine positions.MethodsThis was a comparative study that included a prospective cohort and historical control groups. This study analysed 40 consecutive patients who undergone supine XG-PCNL between October 2019 and March 2020. The control groups were composed of historical control formed from the last 40 consecutive patients who underwent FG-PCNL in both supine and prone positions from our PCNL database from January 2018 and September 2019. Patients’ demographics, stone characteristics and intraoperative and postoperative outcomes were compared.ResultsA total of 120 patients were classified into the supine XG-PCNL, supine FG-PCNL, and prone FG-PCNL groups (each N = 40). They had similar baseline characteristics and initial stone burden. The supine XG-PCNL group had higher puncture attempts, nephrostomy tube placement, and longer surgery duration than both the supine and prone FG-PCNL groups. However, the stone-free rate was similar in all groups (85%, supine XG-PCNL; 72.5%, supine FG-PCNL; 77.5% prone FG-PCNL; p = 0.39). No significant difference was found in the complication rate and length of stay among the three groups.ConclusionSupine XG-PCNL is an alternative to both supine and prone FG-PCNL with similar efficacy and complication rates for kidney stone patients. This could be a good alternative to urological centres with no access to fluoroscopy.