Ultrasound-guided Percutaneous Nephrolithotomy Research Articles

The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous Nephrolithotomy

BackgroundTo evaluate the feasibility and safety of balloon dilation (BD) in totally ultrasound-guided percutaneous nephrolithotomy (PCNL).MethodsThe data of 95 patients underwent BD were collected in this retrospective study between August 2016 and December 2018. During the same period, telescopic metal dilation was used in 1161 patients. Ninety five patients were selected as the control group and matched at a 1:1 ratio to index balloon dilation (BD) cases in regards to Guy’s stone score, age, sex, BMI, degree of hydronephrosis and stone area. Peri-operative data were compared between the two groups.ResultsTotal operative time was significantly shorter in the BD group (62.2 ± 22.4 min vs. 70.2 ± 25.8 min, p = 0.024). Tract establishment time was significantly shorter in the BD group (3.4 ± 1.8 min vs. 4.3 ± 2.3 min, p < 0.001). The success rate of tract dilation by first attempt was higher in the TMD group compared with that of BD group; however the difference was not statistically significant. There was no significant difference between groups with regards to complication and stone-free rates. The cost of PCNL in the BD group was significantly higher than that of the TMD group (US $4831.4 ± 1114.8 vs. US $4328.4 ± 975.7, p = 0.012). Subsequent analysis revealed that mild or no hydronephrosis were risk factor for failure of balloon dilation under ultrasound.ConclusionsBD has acceptable complication and stone free rates compared with those in TMD; however, BD under ultrasound is not suggested for stone cases without hydronephrosis.

The Clinical Application of Puncture Frame in Establishing Ultrasound Guided Percutaneous Nephrolithotomy Access.

To investigate the clinical efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) assisted by a puncture frame. Clinical data of 106 patients with nephrolithiasis who underwent ultrasound-guided percutaneous nephrolithotomy from October 2016 to December 2017 in our hospital were analyzed retrospectively. The channels were established by the assistance of the puncture frame. The mean puncture time was 35 ± 18 seconds, the puncture was performed 1.3 ± 0.9 times on average. The puncture was successfully performed at first attempt in 73 cases. The mean operation time was 67.3 ± 39.2 min, and the mean intraoperative blood loss was 48 ± 22 mL. The stones were located on the left in 50 (47.2%) cases, and on the right in 56 (52.8%) cases. Channels were established through the upper, middle and lower calyces of the kidney in 78 (73.6%), 20 (18.9%), and 8 (7.5%) cases, respectively. The puncture sites were located on the upper and lower of 12th rib in 81 (76.4%) and 25 (23.6%) cases. Intraoperative and postoperative blood transfusion was given in four cases. Pleural injury occurred in two cases, and hydropneumothorax occurred in one case in whom closed thoracic drainage was performed. The stone free rate after a single surgery was 87.7% (93/106). Establishing a percutaneous nephrolithotomy access tract under ultrasound guidance using the puncture frame is an efficacious and safe approach.

PD07-01 3-DIMENSIONAL ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY

INTRODUCTION AND OBJECTIVE:To provide a comprehensive analysis about safety and efficacy of fluoroscopy-free total ultrasound-guided percutaneous nephrolithotomy (TUPN) versus ultrasound with fluor...

Mepilex Border Dressings for the Prevention of Pressure Ulcers Caused by Nephrostomy Tube Securement

Objective: To investigate the clinical effectiveness of Mepilex Border dressings for the prevention of medical device-related pressure ulcers (MDR PUs) caused by the nephrostomy tube securement with the drainage tube. Methods: Equally randomized 60 obstructive hydronephrosis patients in our hospital who were treated by ultrasound-guided percutaneous nephrolithotomy (from March 2018 to March 2019) into observation group and control group. The observation group was applied dressings beneath the junctions of nephrostomy tubes and drainage tubes before secured with 5*5cm I-shaped 3M elastic adhesive tape to avoid direct contact to patients’ skin; the control group was only secured with 5*5cm I-shaped 3M elastic adhesive tape to the bare skin. The incidences of skin indentations, local pain and pressure ulcers under the junctions were compared between two groups. Results: There were statistical significance (P<0.05) among two groups: all patients in control group (n=30) were presented with skin indentations in different degrees, 21 with local pain, 6 with first-stage pressure ulcers, while no evidence of the above situations was found in the observation group. Conclusions: Application of Mepilex Border dressings can prevent the occurrence of MDR PUs to improve patient comfort.

Clinical study of the puncture success rate during ultrasound-guided percutaneous nephrolithotomy

Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy (PCNL) and analyze the reasons of puncture failure. Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years' experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018. Of all the 58 patients, there were 36 males and 22 females (aged from 22 to 73 years) with the mean age of 51 years. The calculi ranged from 9 mm to 93 mm, with the average of 26.5 mm. The separation of renal collecting system ranged from 5 mm to 30 mm, with the average of 15.1 mm. All of the 58 patients underwent one-stage PCNL and the numbers of punctures, the numbers of percutaneous tubes and the reasons for failure were recorded. Results All percutaneous tubes and surgeries were established and done successfully. Of all the 118 punctures, 74 punctures succeeded by detecting the urine and 68 surgery tracts were established (6 punctures failed because of the dilation). The total puncture success rate was 62.7%(74/118). Of the total 74 successful punctures, 56.8%(42/74)succeeded at the first puncture, 28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures. The success puncture rate of the 4 urologists were 59.2%(29/49), 64.1%(25/39), 66.7%(16/24), 66.7%(4/6)respectively, and there were no statistical differences between the puncture success rates of the urologists (P=0.679). Each channel needed 1.7 punctures on average. Fouty-four punctures failed without detecting the urine, including 20 failed punctures because of the puncture tract deviation, 17 punctures without seeing the urine after the core needle being removed, 7 punctures no display on the ultrasound imagine. There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes. Five nephrostomy tubes' position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35). One patient had complications and classified as Grade II or above on the modified Clavien Grading System of aerothorax. Conclusions The puncture success rate during ultrasound-guided PCNL is not satisfied. The main reasons of puncture failure are the deviation of puncture tract, unclear imaging of puncture tract and other unclear reasons( puncture needle went too deep or superficially or tip of the needle embedded into the stone). Key words: Kidney calculi; Percutaneous nephrolithotomy; Puncture; Success rate

X-Ray–Free Ultrasound-Guided Percutaneous Nephrolithotomy at Zagazig university hospital

X-Ray–Free Ultrasound-Guided Percutaneous Nephrolithotomy at Zagazig university hospital

Feasibility and safety of tract dilation under ultrasound guidance in standard percutaneous nephrolithotomy

Objective To investigate the feasibility of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL), and the risk factors for its failure. Methods A retrospective study was conducted on patients underwent PCNL with only one access (F24) using balloon dilator and sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to December 2018 in Beijing Tsinghua Changgung Hospital. A total of 231 patients (130 males and 101 females) underwent ultrasound-guided PCNL with a mean age of (52.3±9.8) years were included in our study. Mean BMI was (25.8±3.1)kg/m2. Mean size of stone was (3.9±1.1)cm, 51.1% (118/231) of which were staghorn stones. Under ultrasound guidance, after puncture of the target calyx, the balloon dilator was advanced through the guide wire, and inflated to establish the F24 standard renal access. Patients’ clinical parameters such as age, gender, BMI, stone diameter, history of open nephrolithotomy were collected. Risk factors for the failure of ultrasound guided balloon dilation were analyzed by logistic regression analysis. Results Tract dilation succeed in 89.2 % cases (206 succeed, 25 failed) at first attempt. Median tract dilation time was 4.2 min (2.2-8.0 min). Mean operation time was 85.5 min(45.0-120.0 min). Median hemoglobin drop at the first postoperative day was 16.0 g/L (5.0-25.8 g/L). The total rate of complication was 9.1% (21 cases), including 18 cases Clavien Ⅰ and 3 cases Clavien Ⅱ. The stone free rate was 89.6%(207/231). Logistic regression analysis revealed that lower pole access (P=0.014) was a risk factor for the failure of access establishment, while the presence of hydronephrosis of target calyx (P<0.001) would significantly increase the success rate. Conclusions Tract dilation using balloon catheter can be safely monitored by ultrasound with high success rate and low complication rate. Lower pole puncture will make tract establishment difficulty. Patients with a hydronephrotic target calyx are more suitable for this procedure. Key words: Kidney calculi; Percutaneous nephrolithotomy; Ultrasound guidance; Balloon dilation

Does Body Mass Index Impact the Outcomes of Ultrasound-Guided Percutaneous Nephrolithotomy?

Background and Purpose: To evaluate whether body mass index (BMI) has an impact on the outcomes of ultrasound-guided percutaneous nephrolithotomy (PCNL). Materials and Methods: The data of 359 patients who required PCNL at ShengJing hospital between June 2013 and July 2015 were reviewed, with the patients divided into 4 groups based on different ranges of BMI: <25, 25–29.9, 30–34.9, and ≥35 kg/m². Baseline characteristics and outcomes were compared between the groups. Multivariable logistic regressions were used to evaluate the independent contribution of BMI as a predictor of outcomes. The Modified Clavien classification system was used for reporting complications. Results were compared between the groups using the chi-square and multivariate logistic regression tests. Results: No significant differences were noted in the demographic data between the 4 groups. Ultrasound screening time, total operative time, and hospital stay all increased with increasing BMI. No difference was found in the complication rate, stone free rate, or need for auxiliary procedures. Conclusion: Obesity does not increase the incidence of complications in ultrasound-guided PCNL, and the efficacy of the technique for obese patients is similar to that for normal weight patients. The lateral decubitus position was preferred in patients with higher BMI.

Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it.

Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists' training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.

Complete Ultrasound-guided Percutaneous Nephrolithotomy in Prone and Supine Positions: A Randomized Controlled Study

ObjectivesTo evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. Patients and methodsThis study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. ResultsThe demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. ConclusionUS-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.

Clinical investigation of ultrasound-guided percutaneous nephrolithotomy accessed by SVOF-principle and two-step puncture techniques

Objective: To evaluate the safety and effectiveness of ultrasound-guided percutaneous nephrolithotomy (PCNL) accessed by SVOF-principle and two-step puncture techniques. Methods: A total of 838 cases with upper urinary stones underwent percutaneous nephrolithotomy successfully accessed by ultrasound-guided between June 2007 and December 2015 at Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Of all cases were divided in two groups: hydronephrosis calyces puncture group include 425 cases and SVOF-principle puncture group include 413 cases. The access establishment time, operation time, stone free rate (SFR), postoperative complications, and postoperative hospitalization time between the two groups we compared by t test or χ2 test. Results: Statistically significant differences were observed between hydronephrosis calyces puncture group and SVOF-principle puncturegroup in the first access establishment time ((16.5±8.4) minutes vs. (11.2±5.9) minutes, t=3.931, P=0.013), one-stage SFR (74.3% vs. 85.7%, χ2=16.868, P=0.000), postoperative hospitalization time ((6.4±2.1) days vs. (4.8±1.8)days, t=4.574, P=0.000), transfusion rate (7.1% vs. 2.9%, χ2=8.027, P=0.006), and embolization rate (3.3% vs. 1.0%, χ2=5.390, P=0.020). There were no statistically significant differences in operation time, total SFR, postoperative fever and sever infection between these two groups (all P>0.05). In both two groups, no serious complications such as peripheral organ injury and death occurred. Conclusions: PCNL accessed guided by ultrasound with SVOF-principle and two-step puncture techniques has advantages of quick puncture location, high stone free rate, fewer complications and fast recovery. This technique is an effective and safe treatment option for upper urinary stones and deserved promotion and application in clinic.

Long-term outcomes of ultrasound-guided percutaneous nephrolithotomy in patients with solitary kidneys: a single-center experience.

To report our experience with total ultrasound-guided percutaneous nephrolithotomy (PCNL) in the management of patients with solitary kidney, and evaluate the safety and feasibility of this technique. Between October 2014 and December 2016, 48 patients with solitary kidneys underwent total ultrasound-guided PCNL at our institution. Stone-free rate (SFR), auxiliary procedures, and complications were recorded. Changes in renal function were evaluated by comparing preoperative and postoperative estimated glomerular filtration rates (eGFRs). Perioperative factors that may affect renal function were analyzed to define factors predicting renal function improvement on long-term follow-up. Of 48 patients, 44 were followed at least 6months, whereas four patients were lost to follow-up. Among all patients, staghorn calculi were found in 18 (37.5%) patients. 14 (29.2%) patients required a two-stage PCNL. Struvite was found in six (12.5%) patients. Complications were reported in eight (16.7%) patients. Severe bleeding was noticed in three patients; no angioembolization was required. After a median follow-up of 12 (6-26) months, the final SFR was 81.8% after auxiliary treatments. There was a significant improvement of eGFR from 53.9 ± 24.0 to 61.3 ± 25.4mL/min/1.73m2 (P < 0.01). Renal function was stable, improved and worse in 65.9% (n = 29), 27.3% (n = 12), and 6.8% (n = 3) of patients, respectively, compared with preoperative levels. Ultrasound-guided PCNL is a safe and feasible procedure with an acceptably low complication rate in patients with solitary kidneys. At long-term follow-up, the renal function in more than 90% of the patients with solitary kidneys can be improved or stabilized after ultrasound-guided PCNL.

Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis

To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL). A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay. Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67-1.35; p = 0.79] irrespective of the patient's position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36-0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes. UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.

Effect of the ultrasound-guided transperitoneal percutaneous nephrolithotomy in treatment of renal calculi in pelvic ectopic kidney

Objective To evaluate the safety and efficacy of ultrasound-guided transperitoneal PCNL for treatment of renal calculi in pelvic ectopic kidney. Methods The clinical data of 4 cases of pelvic ectopic kidney treated in our hospital from June 2016 to August 2017 were retrospectively analyzed. The patient's age ranged from 30 to 67 years with an average of 47.25 years. There were two male and two female patients. 2 cases suffered with left pelvic ectopic kidney stones. One case had right pelvic horseshoe ectopic kidney stones and one case had spinal deformity left pelvic ectopic kidney stones. Multiple stones were found in 2 cases. The mainly stones located in the renal pelvis in one case. Multiple stones in the lower calyx was found in another case. The remaining 2 cases had single stones in the renal pelvis. Stone size was 3.4 cm×2.1 cm, 3.0 cm×2.1 cm, 2.8 cm×2.4 cm and 2.1 cm×1.9 cm respectively. And 1 case with renal calculi in left pelvic ectopic kidney had a history of open surgery 11 years ago because of the same situation with pelvic ectopic kidney calculi. In this study, all operation was performed under general anesthesia. The ultrasound-guided percutaneous nephrolithotomy combined with preoperative CTU and intraoperative color Doppler ultrasound was used to find the target renal calyx or renal pelvis. And a certain pressure was applied to the abdominal wall to make the intestinal canal deviate from the surface of the pelvic ectopic kidney as much as possible. Under ultrasound real-time detection, it was punctured into the target renal calyx or renal pelvis to find and break stones. And F6 double J tube and F18 nephrostomy tube were left. Operative and post-operative related details (stone free, bleeding, abdominal infection) were reviewed. Results Stone free rate were 100% (4/4). The time of operation and hospital stay were 62, 59, 55, 51 min and 6, 6, 5, 5 days, respectively. None had significant intraoperative and postoperative complications, including haemorrhage, injury of mesenteric vessels, abdominal infection and hydrops. No one left residual stones during 1 month and 3 months of follow-up. Conclusions The ultrasound-guided transperitoneal PCNL is a safe and effective procedure for the treatment of patients with renal calculi in pelvic ectopic kidney. Key words: Percutaneous nephrolithotomy; Transperitoneal; Ultrasound-guided; Pelvic ectopic renal calculi

Increasing Body Mass Index Steepens the Learning Curve for Ultrasound-guided Percutaneous Nephrolithotomy

ObjectiveTo define how the learning curve for success in ultrasound-guided percutaneous nephrolithotomy (PCNL) is impacted by body mass index (BMI). Previous research has shown ultrasound-guided PCNL to be an effective method of nephrolithiasis treatment comparable to fluoroscopy-guided PCNL. A common concern for the ultrasound-guided approach is potential imaging difficulty in the obese patient population. MethodsA prospective cohort study of consecutive patients undergoing PCNL with ultrasound guidance for renal tract access was performed. Clinical data collected included success in gaining renal access with ultrasound guidance, patient BMI, and clinical outcomes over time. Nonparametric LOWESS regression modeling was performed in R using locally weighted scatterplot smoother (R version 3.3.3) for gradations of patients by BMI group (<30, 30-40, and >40). ResultsA total of 150 cases were examined. Case number and BMI were evaluated as continuous variables. Multivariate logistic regression revealed that BMI (P = .010; OR 0.93) and case number (P<.001; OR 1.03) were significantly correlated with ultrasound success. Sex, age, hydronephrosis, stone type, puncture location, and stone size did not influence success at obtaining ultrasound-only access in a statistically significant fashion. LOWESS regression modeling of the relationship between case number and renal access success depicts that the curve representative of the BMI >40 group is downward and right-shifted relative to the other two groups. ConclusionThe learning curve for successful ultrasound-guided PCNL is impacted by patient’s BMI as well as case number. Increasing BMI makes access more challenging when performing ultrasound-guided PCNL.

Feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis

Objective To investigate the feasibility and safety of retrograde ureterography combined with ultrasound-guided percutaneous nephrolithotomy for renal calculi complicated with hydronephrosis. Methods From April 2016 to July 2016, 5 patients with renal calculi complicated with hydronephrosis were selected. B-mode ultrasound imaging was compared with contrast-enhanced mode with simultaneous retrograde injection of optison via an ipsilateral ureteral catheter. Results Five patients (four males and one female) with renal stones underwent percutaneous nephrolithotomy (PCNL) with retrograde ultrasound contrast injection during the study period. Mean body mass index was(28.3±5.6)kg/m2 and mean stone size was(24.5±12.0)mm. Under B-mode ultrasound, all patients demonstrated non-dilated renal collecting systems that appeared as hyperechoic areas, where it was difficult to identify a target calix for puncture.Retrograde contrast injection facilitated delineation of all renal calices initially difficult to visualize under B-mode ultrasound. Renal puncture was then performed effectively in all cases with a mean puncture time of(55.4±44.8)seconds. All PCNL procedures were completed without intraoperative complications and no adverse events related to ultrasound contrast injection occurred. Conclusions Retrograde ultrasound contrast injection as an aide for renal puncture during PCNL is a feasible technique. By improving visualization of the collecting system, it facilitates needle placement in challenging patients without hydronephrosis. Future larger scale stu-dies comparing its use to standard ultrasound-guided technique will be required to validate this concept. Key words: Kidney Calculi; Nephrostomy, Percutaneous; Lithotripsy; Urography

Real-Time Ultrasound-Guided Percutaneous Nephrolithotomy Using Newly Developed Wireless Portable Ultrasound: A Single-Center Experience.

To assess the feasibility and utility of a newly developed wireless portable ultrasound "UProbe- 2" for puncture guidance in percutaneous nephrolithotomy (PCNL). The UProbe-2 consists of a probe with integrated ultrasound circuit boards inside, an intelligent terminal that installed specific ultrasound software, and a puncture trestle. The probe can connect to an intelligent terminal via WI-FI. It was used to guide puncture in PCNL in 31 patients who suffered kidney stones or large impacted proximal upper ureteral stones with hydronephrosis from June 2016 to July 2017. Patients' characteristics as well as parameters during operation were collected. PCNL was successfully performed in all patients with the guidance of the UProbe-2. The mean (standard deviation) puncture time was 3.6 (0.9) minutes, and the median operative duration was 50 (35-80) minutes. The primary stone clearance rate was 87% (27/31). No major intraoperative or postoperative complications occurred. The UProbe-2 ultrasound is safe and effective for puncture guidance during PCNL according to this initial study. It could provide a new and alternative choice for guidance of PCNL. However, more clinical trials especially randomized controlled trials should be performed.

Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients: a single-center experience.

To present the safety and efficacy of fluoroscopy-free ultrasound-guided PCNL for the treatment of renal calculi in pediatric patients of all ages. 30 children with mean age of 5years (6months-12years) underwent totally ultrasound-guided PCNL from March 2013 to August 2016. The pyelocalyceal system was punctured in prone position using only ultrasonography guidance, and the tract was dilated using a single shot dilation technique. No fluoroscopy was used during any of the stages of renal access. The procedure was performed using adult-sized instruments. The mean stone size was 27.1±8.7mm. Mean access time was 4.3±2min. Mean nephroscopic time was 34.6±15.2min. Mean hospital stay of patients was 3days (range 2-5). 21 patients were stone-free after the procedure (70% success rate). Only four patients out of 30 experienced postoperative complications. The results of this study showed that fluoroscopic-free ultrasound-guided PCNL in pediatric patients of all ages is safe, highly efficient, and minimizes potential radiation exposure risks associated with the procedure.

Ultrasound-guided percutaneous nephrolithotomy for the treatment in patients with kidney stones.

Background:In this study, we aimed to explore the effect of ultrasound-guided percutaneous nephrolithotomy (UGPN) for the treatment in patients with kidney stones (KS).Methods:We randomly assigned 86 patients with KS to a UGPN group or a control group, each group comprising 43 patients. Patients from the UGPN group underwent UGPN whereas those from control group underwent fluoroscopic-guided percutaneous nephrolithotomy (FGPN). The primary outcome included the stone-free rate. Secondary outcomes included complication rates, operative time, and length of hospitalization.Results:UGPN did not show better efficacy than the FGPN procedure in decreasing stone-free rate (UGPN group 79.1% vs control group 69.8%, P = .45), operative time (UGPN group 108.4 ± 31.7 minute vs control group 113.2 ± 34.5 minute, P = .50), and length of hospitalization (UGPN group 2.7 ± 1.3 days vs control group 3.1 ± 1.5 days, P = .19). Additionally, no complications, except fever (UGPN group 4.7% vs control group 9.3%, P = .41) and hemoglobin slightly reduced (UGPN group 7.0% vs control group 11.6%, P = .46) were noted in patients from both groups in this study.Conclusions:To summarize, we demonstrated that both UGPN and FGPN techniques showed similar efficacy and complications when used for the management of KS.

Supine Ultrasound-guided Percutaneous Nephrolithotomy with Retrograde Semi-rigid Ureteroscopic guidwire retrieval: Description of an Evolved Technique.

Ultrasound-guided PCNL in Galdakao-modified supine Valdivia (GMSV) position has taken into consideration during the last decade; however, guidewire slippage during tract dilatation is still a big concern in this approach. Here we presented our results of combination of this modification with ureteroscopic guidewire retrieval to ensure a safe and confident renal access. From June 2015 to March 2016, 30 consecutive patients with renal stone of ? 2.5 cm were enrolled. After general anesthesia, all patients were positioned in GMSV position. Semi-rigid ureteroscopy up to the renal pelvis was performed by an assistant urologist. Ultrasound (US)-guided renal access and passage of guidewire was performed by another urologist after which the first urologist grasped and retrieved the guidewire from the renal pelvis to the ureter and then out of urethra. Stone manipulation was performed as standard PCNL.All patients were evaluated regarding age, stone burden, anthropometrics measurements, major and minor surgical complications, and stone free rate. Guidewire retrieval was successful in 26 patients (86.7%) and tract dilatation was achieved in all (100%) of this group. In other 4 patients (13.3%) retrograde endoscopic guide wire retrieval failed; in one patient, (3.33%) ureteroscope did not reach the renal pelvis because of tall stature; One patient (3.33%) had narrow calyceal infundibulum which prevented the guidwire passage along the stone to reach to the renal pelvis, and for two patients (6.67%) ureteroscope did not pass the ureteropelvic junction because of narrow ureteropelvic angle. Guidewire retrieval seems to improve the results of US-guided GMSV position PCNL by eliminating the possibility of guidewire slippage during tract dilatation.