Category: Clinical Stones: PCNL

MP26-18 - Reducing Fluoroscopy Time in Percutaneous Nephrolithotomy

Sun, Sep 23
10:00 AM - 12:00 PM

Introduction & Objective :

Stewardship of ionizing radiation of stone patients is an emerging concept in stone disease.  Reducing fluoroscopic time (FT) during percutaneous nephrolithotomy (PCNL) is an opportunity for such stewardship.  We present our initial results of a radiation reduction protocol used during PCNL with fluoroscopic guided access by the urologist.

Methods :

Retrospective chart review of all PCNL cases performed between Jan 1, 2017 and Oct 30, 2017. These were divided in two groups: pre-radiation reduction protocol (group 1) and post-radiation reduction protocol (group 2). Fluoroscopy was done using low-dose and pulsed mode (4 frames per second) whenever feasible. Specific measures implemented to reduce FT include (i) using one spot images instead of live fluoroscopy (ii) increased reliance on tactile feedback, and (iii) using shorter segments of live fluoroscopy. The FT was the primary outcome of the study.

Results :

Ninety-three PCNL procedures were performed in 93 patients, 47 in group 1 and 46 in group 2. Median (range) age, BMI and stone burden (largest axial x largest coronal diameter) was comparable in both groups [Group 1: 55 yrs (29, 81), 32.0 kg/m2 (16.6, 59.6), and 26 x 27mm (5, 110 x 6, 116), respectively. Group 2: 61 yrs (19, 79), 29.9 kg/m2 (16.5, 64.3), and 28 x 33mm (8, 158 x 10, 115), respectively].

The median (range) FT in group 1 and group 2 was 241 (56, 916) and 65 (13, 561) seconds (p<0.0001), respectively. There was a statistically significant difference (p<0.0001) in FT between group 1 and group 2 even after adjusting for BMI and stone burden.

The overall proportion of patients that were stone free was 58.1% (59.6% and 56.5% in groups 1 and 2, respectively (p=0.773), with 10 patients [4 and 6 in groups 1 and 2, respectively (p=0.454)] undergoing ancillary procedures.

Overall complications at 30 days occurred in 4 (9%) and 7 (15%) cases in groups 1 and 2, respectively (p=0.355). Major (Clavien 3a+) complications occurred in 2 (4%) and 4 (9%) cases in groups 1 and 2, respectively (p=0.435).

Conclusions :

FT in PCNL can be significantly reduced by adopting simple techniques and being increasingly vigilant of its usage without compromising peri-operative outcomes, thereby reducing radiation exposure to the surgeon and the patient.

Michael W. Sourial

Assistant Professor of Urology
The Ohio State University Wexner Medical Center
Columbus, Ohio

Andrew M. Todd

Urology Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio

Bodo E. Knudsen

Director, Comprehensive Kidney Stone Program
Ohio State University
Columbus, Ohio