AUA 2016: Ultrasound-guided Renal Access Reduces Radiation Exposure During Percutaneous Nephrolithotomy Compared to Fluoroscopic Guidance - Session Highlights

San Diego, CA USA ( Fluoroscopic guidance is currently the primary technique used to gain renal access during a percutaneous nephrolithotomy (PCNL). Although fluoroscopy provides suitable visualization of the collecting system, it also exposes patients to high doses of ionizing radiation. Similarly, ultrasonography (US) aids in renal access and provides visualization of both collecting system and viscera.

However, radiation exposure and surgical outcomes of US are unclear. To determine which technique is more efficient and minimizes radiation exposure, Margono and colleagues performed a prospective cohort study comparing US- and fluoroscopy-guided renal access during PCNL procedures.

From May 2014 to May 2015, 118 PCNL cases participated in the study. Of those, 70 cases utilized US guidance for all or the majority of renal access and 48 utilized fluoroscopic guidance for the entire procedure. Radiation dose, total operative time, residual stone status, serum creatinine change, hematocrit change, perioperative transfusion rate, surgical complication rate and hospital length of stay were all measured.

All cases contained comparable mean ages, percent of male patients, mean BMI, and mean ASA physical status classification. Patients whom received US guidance during renal access were shown to have received a less total mean radiation dose (18.5 mGy vs. 46.0 mGy, P<0.01) and fluoroscopic screening time (68.9 sec vs. 169.5 sec, P<0.01) resulting in an average dose reduction of 27.5mGy (95% Cl 7.8 to 47.3). No statistical significance was observed in mean values for all remaining variables. The authors concluded from their findings that US-guidance for renal access during a PCNL reduces patient radiation exposure and poses no negative surgical outcomes or efficacy in comparison to fluoroscopic guidance.


Presented By: Christopher Margono, MD

Written By: Brittany Uribe, BS; Junior Specialist, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA