Presentation Authors: Yanbo Wang*, Yuchuan Hou, Chunxi Wang, Changchun, China, People's Republic of
Introduction: Ultrasound is gradually becoming more widely accepted as an alternative technique during percutaneous nephrolithotomy (PCNL). However, accomplishing total real-time ultrasound monitored puncture and dilation and achieving repeatable techniques during PCNL are still challenging. We sought to provide a comprehensive analysis about safety and efficacy of fluoroscopy-freely total ultrasound-guided percutaneous nephrolithotomy (TUPN) versus partial ultrasound-guided percutaneous nephrolithotomy (PUPN).
Methods: Ultrasound-guided PCNL were retrospectively analyzed in 696 patients from 2011 to 2017 in First Hospital of Jilin University. TUPN was performed in 185 patients and PUPN was finished in 511 patients. In TUPN group, the entire procedures of puncture and dilation were only real-time monitored by ultrasound. Conversely, in PUPN group, the puncture was performed under the real-time ultrasound guidance, while the dilation was monitored by fluoroscopy. Preoperative demographic data, intraoperative parameters and postoperative complications were compared.
Results: Groups were comparable in baseline characteristics. All renal punctures were successfully performed. The primary successful rates of dilation were more than 94% in both groups (95.1% in TUPN and 94.9% in PUPN, p=0.91). Two or more accesses were established in 33 patients (17.8%) in TUPN group and 66 patients (12.9%) in PUPN group (p=0.10). Post-operative instant stone free rates (SFR) were 88.6% and 89.6%, TUPN versus PUPN, respectively, p=0.71. There were no differences in Clavien-Dindo complications in both groups. Mean operating time and hospitalization were comparable.
Conclusions: Our findings show that fluoroscopy-free total ultrasound-guided PCNL represents an alternatively safe and efficient approach for the treatment of renal stones. Further studies are needed to support it.