Percutaneous nephrolithotomy is generally performed under fluoroscopy that is associated with exposure to radiation. Another drawback of fluoroscopic-guided percutaneous nephrolithotomy is the prone position, which is not suitable for all patients. In this study we aimed to evaluate the feasibility, safety and efficacy of ultrasound-guided percutaneous nephrolithotomy in flank position.
From December 2010 to July 2016, a total of 603 patients with a mean age of 50.9 ± 13 years, were included in this study. Access to the collecting system and tract dilation were performed under ultrasonography guidance. Perioperative data on stone free rate, operative time, length of stay and complication rates were recorded.
Successful access was achieved in all but one patient and the mean operative time was 56.6 ± 6.5 minutes. Complete stone clearance was achieved in 529 (87.7%) patients and grade 3 complications were encountered in 17 (2.8 %) patients according to the Clavien-Dindo grading system. Blood transfusion was necessary in 43 (7.1%) patients; however bleeding was self-limited in all patients and did not require angioembolization.
This is the largest series of ultrasonography-guided percutaneous nephrolithotomy in flank position and unlike other studies, we used this procedure for all patients irrespective of stone burden, renal anomaly and body habitus. Ultrasonography-guided percutaneous nephrolithotomy has comparable outcomes with the conventional percutaneous nephrolithotomy and is not associated with radiation exposure. Furthermore, anesthesia in the flank position might be less harmful in some patients including those with obesity or cardiopulmonary comorbidities.
The Journal of urology. 2018 Feb 22 [Epub ahead of print]
Seyed Hassan Inanloo, Seyed Reza Yahyazadeh, Samaneh Rashidi, Erfan Amini, Mohammad Reza Nowroozi, Mohsen Ayayti, Hassan Jamshidian, Mohammad Reza Nikoobakht, Seyed Mohammad Kazem Aghamir, Omid Hemmatian, Seyed Ali Momeni
Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Endourology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran., Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Electronic address: ., Department of Urology, Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran., Department of Endourology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.