Presentation Authors: Satyajeet Pattnaik*, PRASHANT KUMAR PATTNAIK, Mumbai, India
Introduction: Purpose:Â _x000D_
It is a well-known fact that Urologists all around the Globe are vastly exposed to ionizing radiation during minimally invasive/endourological procedures hence the application of substitutional means for access to the collecting system and tract dilatation may perhaps be unassailable and cost-effective._x000D_
To compare the Safety and Efficacy of Totally Ultrasound Guided Percutaneous Nephrolithotomy V/S Combination of Ultrasound with Fluoroscopy Guided Percutaneous Nephrolithotomy V/S Completely Fluoroscopy Guided Percutaneous Nephrolithotomy with respect to duration of surgery, size of per-cutaneous tract in millimeters, intra-operative injury/complications, hemorrhage, speed of post-operative recovery, residual calculi, radiation exposure.
Methods: Materials and Methods:Â From September-2015 to February-2016, after careful selection, a total of 150 candidates (115 men and 35 women), with a mean age of 40 (range 23â€“57 yrs.), were included in this study. We divided patients into three groups (A, B and C) after computer-based randomization. Group A (50) including patients undergoing Totally Ultrasound Guided Percutaneous Nephrolithotomy, Group B (52) including Ultrasound combined with Fluoroscopy Guided Percutaneous Nephrolithotomy and Group C (48) including Patients undergoing Completely fluoroscopy guided Percutaneous Nephrolithotomy._x000D_
Percutaneous entry and Tract dilatation was made under either Totally ultrasonographic guidance/ Ultrasound + Fluoroscopic guidance / Totally Fluoroscopic guidance in supine position in all three groups (A, B and C). _x000D_
We included patients with solitary lower calyceal and renal pelvic calculi measuring 1 cm to 2 cm, who had no past history of being operated on the same kidney, had no signs and symptoms of pyonephrosis and gave consent for the study.
Results: Results:Â In group A, mean age of patients was 42.5â€‰Â±â€‰15.54 years and in group B 41.21â€‰Â±â€‰10.72 years and in group C 41Â±11.24 years. The mean stone burden was 17.07, 19.08 and 19.92â€‰mm in groups A , B and C, respectively. Mean operative time in group A was 88.93â€‰Â±â€‰33.29 minutes ,group B it was 79.29â€‰Â±â€‰16.74 minutes and in group C was 81Â±22 minutes. Stone-free rate was 96.4% in group A and 98.2% in group B, 92.2% in group C. Hospital stay was 36.88â€‰Â±â€‰17.25 , 30.20â€‰Â±â€‰17.71 hours and 32Â±17.50 hours in groups A ,B and C respectively. None of the patients required transfusion.No nephrostomy drain was kept post-operatively in all patients. In our study, there were no pleural effusion, postoperative hematoma, renal pelvis perforation, and visceral organ trauma in any groups.
Conclusions: Conclusion:Â We conclude that totally ultrasound-guided PCNL and Ultrasound and fluoroscopy combined PCNL is safer and more feasible than Totally Fluoroscopy guided PCNL. It has benefits of such as reduction/elimination of ionizing radiation exposure to patient & operating personnel, identification of intervening soft tissues between skin and kidney, visualization of renal parenchymal vasculature._x000D_
To summarize, PCNL with Combination of Ultrasound & Fluoroscopy gave the surgeon an added advantage of having dual imaging modalities at his disposal (i.e. Fluoroscopy and Ultrasound) thus judiciously using fluoroscopy for accurate manoeuvres but to curtail radiation exposure using Ultrasound and also served as an ergonomically friendly transition tool for the novice Urologists who aspire to considerably diminish radiation exposure in their operating environments.