Ultrasound-guided Percutaneous Nephrolithotomy Research Articles

Application of Mixed Reality Technology in the Planning of PCNL for Special Types of Complex Upper Urinary Stones: A Pilot Study

ObjectiveTo evaluate the application of Mixed Reality technology in the planning of ultrasound-guided PCNL for special types of complex upper urinary stones. MethodsClinical data of 15 patients with complex upper urinary stones undergoing ultrasound-guided PCNL were analysed which included pelvic ectopic kidney, horseshoe kidney, spinal deformity, and transplant kidney. Based on preoperative CTU data, digital three-dimensional reconstruction is performed, and AI mixed reality is used to project three-dimensional images in real space. This facilitates preoperative design and planning. The consistency rate of target calyx and channel numbers, stone free rate, total operative time, percutaneous renal access establish time, decrease in hemoglobin level, surgical complications, and postoperative hospital stay are analyzed. ResultsAll patients underwent preoperative planning using mixed reality and successfully completed PCNL. Based on the preoperative planning, we utilized S-PCNL alone or combined with Needle-perc or antegrade/retrograde FURS. The consistency rate between preoperative planning and intraoperative completion was 87.6%. The stone free rate was 80%. The average time for establishing the main tract was 2.3±0.3 minutes, and the average total operative time was 61.5±12.2 minutes. The mean decrease in hemoglobin level was 9.6±1.2 g/L, and the average postoperative hospital stay was 4.6±0.5 days. There were no occurrences of Clavien-Dindo grade≥II complications. ConclusionPreoperative quantification and analysis of imaging data through mixed reality enable three-dimensional visualization and facilitate surgical plans, and effectively avoid the risks of surrounding organ injury in these special urinary stones cases, make complex surgeries smoother and more controllable.

Intravenous Nephrostomy Misplacement in Inferior Vena Cava after Percutaneous Nephrolithotomy

A 43-year-old man underwent left ultrasound-guided percutaneous nephrolithotomy [...]

Conventional ultrasonography enabled with augmented reality needle guidance for percutaneous kidney access: An innovative methodologies randomized controlled trial.

Successful needle puncture of the renal collecting system is a critical but difficult procedure in percutaneous nephrolithotomy (PCNL). Although fluoroscopy and ultrasound are the standard imaging techniques to guide puncture during PCNL, both have known limitations. To assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. This study employed a single-center randomized controlled trial (RCT) design to assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. Conducted between May 2021 and November 2021, the trial utilized computer-generated random numbers for participant allocation to control for selection bias. The trial was executed at the *********, which serves as an academic medical center. All patients who met the inclusion criteria were randomly divided into two groups, with 29 patients in each group. One group underwent PCNL procedures using the new navigation system, while the control group underwent standard ultrasound-guided PCNL procedures. Included patients had renal pelvis or caliceal calculi larger than 2.0cm in diameter or had multiple or staghorn stones. The puncture procedure was performed with the support of real-time ultrasound imaging and visual guidance displayed on the screen. The primary outcome was system feasibility and puncture success rate. Secondary outcomes included puncture time, total surgical time, number of attempts, post-procedure complications, and one-year and three-year stone recurrence rates. Stone clearance was defined by postoperative CT. Descriptive statistics summarized patient demographics, stone size, and location. Independent samples t-tests analyzed puncture time and total surgical time. Chi-square or Fisher's exact tests compared stone clearance, complications, socioeconomic status, renal hydronephrosis, stone location, race, and medical history. Linear regression examined the correlation between BMI and puncture time. Significance was set at P<0.05. For all 58 patients undergoing PCNL, needle punctures of the renal collecting system were completed with a success rate of 100%. The average time from planning the puncture protocol to successful puncture was significantly shorter in the AcuSee guidance system group (3.12min, range 0.2-6.88min) compared to the standard ultrasound-guided group (7.58min, range 5.41-10.68min), representing a reduction of approximately 59%. The total surgical time was also shorter in the AcuSee group for patients with no and mild hydronephrosis (P<0.05). Complication rates were lower in the AcuSee group, with no major complications observed. However, 3 patients in the standard ultrasound-guided group have adverse effects after the PCNL procedure. The one-year stone recurrence rate was significantly lower in the AcuSee group (3.4%) compared to the standard group (24.1%), and the three-year recurrence rate was also lower (6.9% vs. 41.4%). Patient-specific factors such as BMI, renal morphology, and prior surgical history did not significantly affect the performance of the AcuSee system. We report the first clinical application of a new navigation system for needle puncture in ultrasound-guided PCNL. It has been demonstrated that it is feasible and safe compared to the standard ultrasound-guided group in percutaneous renal puncture. This technology provides intuitive and easy-to-use visual guidance, which may facilitate safe, accurate and fast needle puncture of the kidney.

Evaluating the results of kidney stone treatment by ultrasound-guided percutaneous nephrolithotomy without preoperative indwelling ureteral catheter

Evaluating the results of kidney stone treatment by ultrasound-guided percutaneous nephrolithotomy without preoperative indwelling ureteral catheter

Ultrasound-guided percutaneous nephrolithotomy versus conventional c-arm-guided percutaneous nephrolithotomy: a prospective randomized comparative study

BackgroundUltrasound guidance for renal access in percutaneous nephrolithotomy (PCNL) is a safe, effective, and low-cost procedure. The current study compared the safety and effectiveness of ultrasound-guided PCNL (US-PCNL) for renal stone therapy versus fluoroscopy-guided PCNL (FL-PCNL) in prone position.ResultsSuccessful puncture was attained in all cases in both groups. Unlike fluoroscopy, US guidance reduced the time needed for achieving renal puncture that was (22.45 ± 6.95 s) compared to fluoroscopy that was (68.28 ± 56.76 s) (P value < 0.001). The mean duration of access that was reported in our study was (3.92 ± 0.72 min) in the US-PCNL group and (4.03 ± 0.77 min) in the FL-PCNL group (P value 0.460). There was no significant difference in the total operative time between both groups in our study as the mean operative time in the US-PCNL group was (61.47 ± 6.07 min) and (65.86 ± 20.86 min) in the FL-PCNL group with a (P value of 0.349). Stone-free rate was nearly similar in both groups (P value 0.336). Three cases in our study in the FL-PCNL group had bleeding that required blood transfusion post-operative; mean Hb change was 0.23 g/dL and 0.55 g/dL in US-PCNL and FL-PCNL groups, respectively, which is clinically irrelevant despite statistical significance (P value 0.007). Mean fluoroscopy time was (6.38 ± 3.84) minutes in FL-PCNL group.ConclusionUltrasound guidance is a reliable tool in the hands of experienced urologists in performing PCNL with less or even zero radiation.

Comparing Balloon Dilation to Non-Balloon Dilation for Access in Ultrasound-Guided Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis.

This study aims to evaluate the safety and efficacy of ultrasound-guided balloon dilation compared to non-balloon dilation for percutaneous nephrolithotomy (PCNL). A systematic review and meta-analysis were conducted by searching PubMed, EMBASE, and the Cochrane Library. Results were filtered using predefined inclusion and exclusion criteria as described and meta-analysis was performed using Review Manager 5.4 software. A total of six studies involving 1189 patients who underwent PCNL were included. The meta-analysis results demonstrated that compared to non-balloon dilation, balloon dilation was associated with reduced haemoglobin drop [mean difference (MD) = -0.26, 95% CI = -0.40 ~ -0.12, P = 0.0002], decreased transfusion rate [odds ratio (OR) = 0.47, 95% CI = 0.24 ~ 0.92, P = 0.03], shorter tract establishment time (MD = -1.30, 95% CI = -1.87 ~ -0.72, P < 0.0001) and shorter operation time (MD = -5.23, 95% CI = -10.19 ~ -0.27, P = 0.04). Overall, ultrasound-guided balloon dilatation offered several advantages in PCNL procedures. It facilitated faster access establishment, as evidenced by shorter access creation time. Additionally, it reduced the risk of kidney injury by minimizing postoperative haemoglobin drop and decreasing the need for transfusions. Moreover, it enhanced the efficiency of surgery by reducing the operation time. However, it is important to note that the quality of some included studies was subpar, as they did not adequately control for confounding factors that may affect the outcomes. Therefore, further research is necessary to validate and strengthen these findings.

Evaluation of the safety and efficiency of color Doppler ultrasound-guided percutaneous nephrolithotomy in clinical practice: results from a retrospective study

This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ∼1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence.

Comparing the effectiveness of ultrasound-guided percutaneous nephrolithotomy in the flank suspended supine, supine, and prone positions in management of renal stones in obese patients: A retrospective single center cohort study

ObjectiveTo assess the efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) in obese patients with renal stones by comparing different positions, namely supine, prone, and flank suspend supine positions. MethodsIn this retrospective analysis, we examined our collected database comprising 123 patients who underwent PCNL. The study focused on adult obese patients between the ages of 18 years and 70 years, with a body mass index ranging from 30 kg/m2 to 40 kg/m2 and renal stones measuring ≥2 cm in diameter. Patients were classified into three equal groups based on their PCNL positions: Group I consisted of patients undergoing flank suspended supine position PCNL; Group II included patients undergoing supine PCNL; and Group III comprised patients undergoing prone PCNL. We assessed comorbidities, conducted clinical examinations, and laboratory investigations, and recorded information about laterality and the grade of hydronephrosis. Various imaging studies, such as abdominal-pelvic ultrasound, bladder radiography, kidney, ureters, and noncontract spiral CT, were also performed. ResultsGroup I demonstrated significantly shorter operative time and hospital stay compared to both Group II and Group III (p < 0.05), while there was no significant difference between Group II and Group III. Stone-free rate was 70.7% in Group I, 61.0% in Group II, and 48.8% in Group III. The success rate was 68.3% in Group I, 51.2% in Group II, and 46.3% in Group III. ConclusionUltrasound-guided PCNL in obese patients is viable, offers real-time visualization of the access needle, and decreases radiation exposure. Flank suspended supine position seems to be as secure and efficient than other positions for these patients.

Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: a comparative study.

Percutaneous nephrolithotomy (PCNL) is considered gold standard treatment of renal stones larger than 20mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than fluoroscopy. A higher body mass index (BMI) can make ultrasound-guided renal access more difficult and unsuccessful. We present a prospective analysis and comparison of ultrasound-guided PCNL in patients with normal and increased body mass index. We performed a prospective comparison of patients who underwent ultrasound-guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-obese) were compared to those with BMIs less than 30 (mean 25.69-non-obese). Demographic, perioperative, and follow-up data were collected, analyzed, and included in this study. Total of 98 consecutive patients, with 49 patients in each group were analyzed. No statistically significant differences were observed in terms of stone volume (P = 0.085), stone density (P = 0.5590), location of renal access (P = 0.108), surgery duration (P = 0.38), blood loss (P = 0.54), or laboratory changes after surgery (P = 0.60). 87.76% of obese patients were stone free per CT scan at follow-up, compared to 73.47% of normal-weight patients (P = 0.1238). According to Clavien-Dindo classification, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to six patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications. There was no significant correlation between body mass index and the success or safety of ultrasound-guided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone-free status postoperatively and can diminish or avoid both patient's and medical team's exposure to ionizing radiation.

Effects of standardized language on remote ultrasound-guided percutaneous nephrolithotomy training: A mixed-methods explorative pilot study

BackgroundRemote teaching of procedural skills has demonstrated equivalence in knowledge acquisition compared to in-person teaching. Variations in terminology for probe and needle movements may serve as a barrier in remote training of ultrasound (US)-guided renal access for percutaneous nephrolithotomy (PCNL). This pilot study investigated the utility of standardized terminology in remote training of US-guided renal access for PCNL. HypothesisStandardization of verbal terminology to describe US probe and needle movement instruction improves remote teaching of US-guided renal access. MethodsFifteen urology residents (PGY1-6) were stratified by year and randomized into two groups. We provided participants with images illustrating US probe and needle movements labeled with predetermined standardized terminology for the intervention group and images without labels for the control group. Both groups were asked to perform US-guided renal access on a training mannequin with a remote faculty educator with (intervention) or without (control) use of standardized movement instructions. Quantitative outcomes included number of attempts and time to achieve access. All trainees completed pre- and post-session surveys and participated in focus groups; authors conducted thematic analysis of focus group transcripts. ResultsDifferences in primary outcomes between groups, including number of attempts and time to achieve access of the renal pole, were not statistically significant. Analysis of focus group interviews revealed that the use of standardized terminology in the setting of remote training can reduce trainee confusion by clarifying ambiguity in educator feedback. DiscussionUse of standardized terminology during remote surgical skills training allows for more effective feedback to trainees.

Correlation Between the Grade of Hydronephrosis with Surgical Outcomes After Ultrasound-guided Supine Percutaneous Nephrolithotomy: A Retrospective Observational Study.

The preferred therapy for staghorn stones and large kidney stones is percutaneous nephrolithotomy (PCNL). Ultrasound-guided PCNL has definite advantages over fluoroscopy-guided PCNL. Preoperative characteristics are essential to assess better surgical outcomes. The goal of this study was to analyze the correlation of hydronephrosis with surgical outcomes after ultrasound-guided supine PCNL. A retrospective study was conducted at Doris Sylvanus General Hospital. Data of the patients was obtained from hospital records. Hundred and five patients underwent ultrasound-guided PCNL in the supine position from August 2020 to August 2022. Data were analyzed using SPSS 16.0. The presence of hydronephrosis was 85 (80.95%), which consisted of Grade I 15 (14.30%), Grade II 25 (23.80%), Grade III 28 (26.70%), and Grade IV 17 (16.20%). In our study analysis, complications occurred in 16 patients (15.23%). Grade I complications of the Clavien-Dindo classification was of in 4 cases, 11 cases of grade 2 complications, and 1 patient died. The statistical result was the relationship between grade hydronephrosis and the grade of complication using the modified Clavien-Dindo system. We found a p-value of 0.207 (>0.05), and there is no statistically significant relationship p=0.382 and r=-0.086 was a negative correlation. There is also no statistically significant relationship between hydronephrosis and stone clearance with p=0.310. The use of ultrasonographic guidance PCNL has been reported as a safe and effective procedure for the management of large renal stones. In this study, there was no correlation or signification between hydronephrosis and surgical outcome after ultrasound-guided supine PCNL.

Giant staghorn stone causing inferior vena cava compression: a novel case report.

We report a case of a 63-year-old male who presented with chronic abdominal pain, hepatosplenomegaly, and normal renal function. He was later diagnosed with polycythemia vera. Computed tomography of the abdomen revealed massive, bilateral staghorn stones measuring 7.3×5.5cm and 1.8×4.5cm on the right and left, respectively. Additionally, the right stone was found to be compressing the inferior vena cava (IVC). The patient was promptly scheduled for right-sided PCNL and the target of 80% stone fragmentation was successfully attained. We present the first case of a stone of such size in the Middle East, as well as the first known case of a renal stone compressing the IVC. Unlike previous reports, the stone was successfully fragmented via PCNL - a procedure that has not been described for stones of such size. This report highlights that ultrasound-guided PNCL without any other intervention is sufficient for the successful treatment of giant SC. Greater research is needed on the potential utility of using ultrasound-guided PCNL for the fragmentation of stones sized over 5cm.

Contrast-enhanced ultrasound versus conventional ultrasound-guided percutaneous nephrolithotomy in patients with a non-dilated collecting system: results of a pooled analysis of randomized controlled trials

BackgroundContrast-enhanced ultrasound in percutaneous nephrolithotomy (CEUS-PCNL) is an economical and practical technique for the treatment of patients with renal stones without significant collecting system dilatation. The aim of this systematic review is to compare the safety and efficacy of CEUS-PCNL and conventional ultrasound (US)-guided (US-PCNL) treatment of patients with renal calculi without significant hydronephrosis.MethodsThis review was conducted with strict adherence to the PRISMA guidelines. Comparative studies on CEUS-PCNL and US-PCNL published in PubMed, SinoMed, Google Scholar, Embase, and Web of science until March 1, 2023, were systematically searched. RevMan 5.1 software was used for meta-analysis. Pooled odds ratios (ORs), weight mean differences (WMDs) and standard mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using the fixed-effects or random-effects model. Publication bias was evaluated using funnel plots.ResultsFour randomized controlled trials involving 334 patients (168 with CEUS-guided PCNL and 166 with US-guided PCNL) were identified. There was no statistically significant difference between CEUS-guided PCNL and US-guided PCNL in terms of the operation time (SMD: − 0.14; 95% CI − 0.35 to 0.08; p = 0.21), minor complications (p = 0.48), major complications (p = 0.28) and overall complications (p = 0.25). However, CEUS-guided PCNL had a higher stone-free rate (OR: 2.22; 95% CI 1.2 to 4.12; p = 0.01), higher success rate of single-needle punctures (OR:3.29; 95% CI 1.82 to 5.95; p < 0.0001), shorter puncture time (SMD: − 1.35; 95% CI − 1.9 to − 0.79; p < 0.00001), shorter hospital stay (SMD: − 0.34; 95% CI − 0.55 to − 0.12; p = 0.002) and lesser hemoglobin loss (SMD: − 0.83; 95% CI − 1.06 to − 0.61; p < 0.00001) as compared with conventional US-guided PCNL.ConclusionsAccording to almost all pooled data, CEUS-guided PCNL is superior to US-guided PCNL in terms of the perioperative outcomes. However, many rigorous clinical randomized controlled studies are required to obtain more accurate results.Registration The study protocol was registered with PROSPERO (CRD42022367060).

Comparison of hemodynamic and respiratory outcomes between two surgical positions for percutaneous nephrolithotomy: a prospective, randomized clinical trial

IntroductionPercutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large and complex kidney stones. ObjectivesThe objective of this study is to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) for patients in the flank position versus prone position. MethodsIn our prospective randomized trial, 60 patients who would undergo fluoroscopy and ultrasound-guided PCNL in prone or flank position were divided into two groups. Demographic features, hemodynamics, respiratory and metabolic parameters, postoperative pain scores, analgesic requirements, amount of fluid given, blood loss and transfusion, duration of operation and hospital stay, and perioperative complications were compared. ResultsPaO2, SaO2, SpO2 and Oxygen Reserve İndex (ORi) at the 60th minute of the operation and in the postoperative period, Pleth Variability index (PVi) at the 60th minute of the operation, driving pressure in all time periods and the amount of bleeding during the operation were determined to be statistically significantly higher in the prone group. There was no difference between the groups in terms of other parameters. Was found to be statistically significantly higher in the prone group. ConclusionsDue to our results the flank position can be preferred in PCNL operations, considering that the position should be chosen according to the surgeon's experience, the patient's anatomical and physiological data, positive effects on respiratory parameters and bleeding, and the operation time can be shortened as the experience increases.

Correlation analysis between renal anatomical factors and residual stones after an ultrasound-guided PCNL.

To predict the factors of residual stones after percutaneous nephrolithotomy (PCNL) by analyzing the characteristics of the renal anatomical structure in intravenous urography, so as to make a reasonable operation plan, reduce the risk of residual stones in PCNL, and improve the stone-free rate (SFR). A retrospective study was performed between January 2019 and September 2020 for patients treated with PCNL. According to the results of a kidney ureter bladder review after PCNL, 245 patients were divided into a residual stone group (71 patients, stone size >4 mm) and a stone-free group (174 patients, stone size ≤4 mm). An independent sample t-test was used to analyze the age, the length and width of channel calices, the angle between the channel calices and the involved calices, and the length and width of the involved calices. The gender, the channel types, the number of channels, the degree of hydronephrosis, and the number of involved calices were analyzed by using the chi-square test. A score of p < 0.05 was considered statistically significant. At the same time, logistic regression analysis was carried out to explore the independent influencing factors of the SFR after PCNL. A total of 71 patients developed residual stones after surgery. The overall residual rate was 29.0%. The width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.007), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calices (p < 0.001) were all significantly correlated with residual stones after PCNL. Logistic regression analysis showed that the width of the channel calices (p = 0.003), the angle between the channel calices and the involved calices (p = 0.012), the width of the involved calices (p < 0.001), the channel types (p = 0.008), and the number of involved calyces (p < 0.001) were all independent influencing factors of the SFR after PCNL. A larger caliceal neck width and angle can reduce the risk of residual stones. The more calyces that are involved, the higher the risk of residual stones. There was no difference between F16 and F18, but F16 had a higher SFR than F24.

Comparison between Ultrasound and Fluoroscopy-guided Percutaneous Nephrolithotomy (PCNL) at Raden Mattaher Jambi Hospital

PurposeTo investigate the effectiveness and safety of ultrasound-guided and Percutaneous Nephrolithotomy (PCNL) compared to the standard fluoroscopy-guided PCNL.MethodsThis study is a comparative retrospective study obtained from medical records within the last 5 years of Raden Mattaher Hospital, Jambi. Patients were divided into 2 groups, fluoroscopy- and ultrasonography-guided PCNL with large kidney stone > 20 mm. Patient characteristics were divided into pre- and post-operative procedures and analyzed using SPSS ver. 25.0 (SPSS Inc., Chicago, IL, USA). Data were analyzed using Kolmogorov–Smirnov, chi-square and/ Fischer’s exact test and p value < 0.05 was considered statistically significant.ResultsOf 201 patients’ data from medical records were divided into ultrasound-guided and fluoroscopy-guided groups. Ultrasound-guided group were consisted of 89 patients and fluoroscopy-guided were of 112 patients. US Guided significantly identifies the severity of hydronephrosis compared to PCNL. The demographic data obtained age, sex, body mass index, and preoperative hemoglobin levels showed a normal distribution. On the post-operative results, significant results occurred in post-PCNL stent placement. Installation of a DJ stent alone is more commonly performed on fluoroscopy-guided PCNL procedures compared to ultrasound-guided PCNL. This had a positive impact on post-procedure outcomes, meaning that the post-operative outcome of ultrasound-guided PCNL was better than that of fluoroscopy-guided PCNL.ConclusionThe reported data demonstrate that PCNL and ultrasound-guided has similar efficacy and complication rates with PCNL fluoroscopy-guided. This could be a good alternative in urological centers with no access to fluoroscopy. However, ultrasound-guided group was still associated with higher rate nephrostomy tube placement and longer surgery duration.

V02-07 DEVELOPMENT AND VALIDATION OF A BENCHTOP SIMULATOR FOR ULTRASOUND GUIDED PERCUTANEOUS NEPHROLITHOTOMY TRAINING USING 3D PRINTING AND HYDROGEL MOLDING

You have accessJournal of UrologyCME1 Apr 2023V02-07 DEVELOPMENT AND VALIDATION OF A BENCHTOP SIMULATOR FOR ULTRASOUND GUIDED PERCUTANEOUS NEPHROLITHOTOMY TRAINING USING 3D PRINTING AND HYDROGEL MOLDING Lauren Shepard, Nathan Schuler, Aaron Saxton, Patrick Saba, Andrew Cook, Tyler Holler, Karen Stern, David Tzou, Helena Chang, Justin Ahn, Thomas Tailly, Thomas Chi, and Ahmed Ghazi Lauren ShepardLauren Shepard More articles by this author , Nathan SchulerNathan Schuler More articles by this author , Aaron SaxtonAaron Saxton More articles by this author , Patrick SabaPatrick Saba More articles by this author , Andrew CookAndrew Cook More articles by this author , Tyler HollerTyler Holler More articles by this author , Karen SternKaren Stern More articles by this author , David TzouDavid Tzou More articles by this author , Helena ChangHelena Chang More articles by this author , Justin AhnJustin Ahn More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Thomas ChiThomas Chi More articles by this author , and Ahmed GhaziAhmed Ghazi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003232.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultrasound-guided percutaneous nephrolithotomy (US-PCNL) is an effective and safe approach for management of large renal stones, yet adoption has been limited. The vast majority of US-PCNL are performed in the prone position vs supine position (80% vs 20%); however, there is a need for a safe, realistic procedural training platform for both approaches. We have previously demonstrated the ability of similar hydrogel simulations to improve operative outcomes during fluoroscopic PCNL training. Our objective was the development of a benchtop, non-biohazardous US-PCNL simulator using 3D printing and hydrogel molding and its validation using educational theory. METHODS: Consensus among 12 experts was reached regarding the essential aspects of an ideal US-PCNL model and an associated evaluation checklist using a Delphi consensus methodology. Segmentation software was used to generate a 3D model from an approved patient computed tomography (CT) scan, including kidney, pelvicalyceal system, stone, spine and ribs, abdominal wall, and iliac crest. Post-processing generated 3D printed casts into which hydrogel formulations replicating various anatomical and tissue mechanical properties of the structures were created according to the consensus statement. A prototype was fabricated for expert approval, after which 20 experts and 28 novices performed US-PCNL with performance assessed using the developed checklist. RESULTS: The simulator fulfilled all criteria established in the consensus statement, including external and ultrasound appearance mimicking in vivo appearance, a watertight pelvicalyceal system containing a functional stone that is distensible with retrograde instillation, and realistic tactile feedback during puncture. Experts agreed the simulator provides a safe training alternative (100%), bridges gaps between classroom and clinic (95.7%), and allows trainee performance evaluation (100%) in a risk free environment that can be modified for variable anatomy (88.9%). Highly significant differences were found between expert and novices using the checklist developed (93.4% vs 42.3%, p<0.001). In addition, novice performance improved with repeated practice (p<.001). A similar process was utilized to develop a supine version for US-PCNL simulation. CONCLUSIONS: We have successfully developed and validated a high-fidelity benchtop simulator for both Prone and Supine US-PCNL that can be easily tailored to varying anatomy. Further studies evaluating the transfer of skill are still required. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e170 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lauren Shepard More articles by this author Nathan Schuler More articles by this author Aaron Saxton More articles by this author Patrick Saba More articles by this author Andrew Cook More articles by this author Tyler Holler More articles by this author Karen Stern More articles by this author David Tzou More articles by this author Helena Chang More articles by this author Justin Ahn More articles by this author Thomas Tailly More articles by this author Thomas Chi More articles by this author Ahmed Ghazi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP35-14 A NOVEL PREOPERATIVE SCORING SYSTEM FOR PREDICTING SUCCESSFUL RENAL ACCESS FOR ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyCME1 Apr 2023MP35-14 A NOVEL PREOPERATIVE SCORING SYSTEM FOR PREDICTING SUCCESSFUL RENAL ACCESS FOR ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY Ukrit Rompsaithong, Heiko Yang, Wilson Sui, Rei Unno, David Bayne, Justin Ahn, Marshall Stoller, and Thomas Chi Ukrit RompsaithongUkrit Rompsaithong More articles by this author , Heiko YangHeiko Yang More articles by this author , Wilson SuiWilson Sui More articles by this author , Rei UnnoRei Unno More articles by this author , David BayneDavid Bayne More articles by this author , Justin AhnJustin Ahn More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003269.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Renal access remains a challenging but important step in successful percutaneous nephrolithotomy (PCNL). Understanding factors that predict successful access will help operative planning. With ultrasound guidance for renal access being adopted for widespread clinical practice, this study aimed to develop and validate a novel preoperative scoring system for predicting renal access difficulty for ultrasound-guided PCNL. METHODS: We analyzed consecutive patients undergoing ultrasound-guided PCNL from the Registry for Stones of the Kidney and Ureter (ReSKU) between 2015 and 2022. A risk model was created using a randomized data-splitting approach, using 70% for model development and 30% for model validation. Ultrasound-guided access failure was defined as the inability to puncture the renal calyx of choice using ultrasound-only guidance. To create a multivariate model, the preoperative variables were determined using forward selection and modified according to clinical judgment. The predictive scores were created by weighting the coefficients of each significant factor. The total scores were classified into three risk groups according to the prevalence and the correlation of difficult renal access. The final model was validated. RESULTS: Three hundred renal units were used for model development and 90 for validation. Four significant factors were identified in the final model and scored: body mass index ≥40 kg/m2 (2 points), no/mild hydronephrosis (4 points), staghorn (5 points), and diverticular stone (7 points) (Table 1). The total scores were categorized into low (0-4 points), moderate (5-8 points), and high difficulty (9-18 points), with a failure rate of 4.1%, 15.4%, and 50% in each group, respectively. This scoring system had a sensitivity of 78.1% and specificity of 80.7% in predicting failures over the moderate difficulty cut-point. The area under the receiver-operating characteristic (ROC) curve in the final model and the validation group were 85.5% and 87.7%, respectively. CONCLUSIONS: Our novel scoring system may be an effective screening tool to identify difficult cases for ultrasound-guided access. In these patients, we suggest having backup imaging modalities available for alternate means of achieving access. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e474 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ukrit Rompsaithong More articles by this author Heiko Yang More articles by this author Wilson Sui More articles by this author Rei Unno More articles by this author David Bayne More articles by this author Justin Ahn More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...

MP23-03 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SUCCESS RATES IN PATIENTS WITH ELEVATED BODY MASS INDEX, A COMPARATIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP23-03 ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) SUCCESS RATES IN PATIENTS WITH ELEVATED BODY MASS INDEX, A COMPARATIVE STUDY Dolev Perez, David Dotan, Binyamin Neeman, Boris Chertin, and Ilan Kafka Dolev PerezDolev Perez More articles by this author , David DotanDavid Dotan More articles by this author , Binyamin NeemanBinyamin Neeman More articles by this author , Boris ChertinBoris Chertin More articles by this author , and Ilan KafkaIlan Kafka More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) is considered the gold standard for the treatment of renal stones larger than 20 mm. Several studies have shown that ultrasound guidance during this procedure is more effective and safer than fluoroscopy. A higher body mass index (BMI) can make ultrasound- guided renal access more difficult and unsuccessful. We present a retrospective analysis and comparison of ultrasound- guided PCNL in patients with normal and increased body mass index. METHODS: We performed a retrospective comparison of patients who underwent ultrasound- guided PCNL to remove renal stones by a single surgeon between 2020 and 2022. Patients with BMIs greater than 30 (mean 33.87-Obese) were compared to those with BMIs less than 30 (mean 25.69-non-Obese). Demographic, preoperative, and follow- up data were collected, analyzed, and included in this study. RESULTS: The study included a total of 98 consecutive patients, with 49 patients in each group. No statistically significant differences were observed in terms of stone volume (p=0.085), stone density (p=0.5590), location of renal access (p=0.108), surgery duration (p=0.38), blood loss (p=0.54), or laboratory changes after surgery (p=0.60). 91.84 precent of obese patients were stone- free per CT scan at follow- up, compared to 77.5 percent of normal- weight patients (p=0.089). According to Clavien Dindo classification, six patients in the non-obese group experienced grade II (10%) and grade III (2%) complications, as opposed to five patients in the obese group with grade I (2%), grade II (6%), and grade III (2%) complications. CONCLUSIONS: There was no significant correlation between body mass index and the or safety of ultrasound- guided PCNL. Although more challenging, a higher BMI should not be an impediment to performing this approach. This method is safe, with no increased incidence of postoperative complications or compromise in stone- free status post- operatively, and can diminish or even avoid both patient's and medical team's exposure to ionizing radiation. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e306 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dolev Perez More articles by this author David Dotan More articles by this author Binyamin Neeman More articles by this author Boris Chertin More articles by this author Ilan Kafka More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparación de los resultados hemodinámicos y respiratorios entre dos posiciones quirúrgicas para la nefrolitotomía percutánea: ensayo clínico prospectivo y aleatorizado

IntroductionPercutaneous nephrolithotomy (PCNL) has become the gold standard for the treatment of large and complex kidney stones. ObjectivesThe objective of this study is to evaluate the efficacy and safety of PCNL for patients in the flank position versus prone position. MethodsIn our prospective randomized trial, 60 patients who would undergo fluoroscopy and ultrasound-guided PCNL in prone or flank position were divided into two groups. Demographic features, hemodynamics, respiratory and metabolic parameters, postoperative pain scores, analgesic requirements, amount of fluid given, blood loss and transfusion, duration of operation and hospital stay, and perioperative complications were compared. ResultsPaO2, SaO2, SpO2 and oxygen reserve index (ORi) at the 60th minute of the operation and in the postoperative period, pleth variability index (PVi) at the 60th minute of the operation, driving pressure in all time periods and the amount of bleeding during the operation were determined to be statistically significantly higher in the prone group. There was no difference between the groups in terms of other parameters. Was found to be statistically significantly higher in the prone group. ConclusionsDue to our results the flank position can be preferred in PCNL operations, considering that the position should be chosen according to the surgeon's experience, the patient's anatomical and physiological data, positive effects on respiratory parameters and bleeding, and the operation time can be shortened as the experience increases.