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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2018 June;177(6):266-70

DOI: 10.23736/S0393-3660.17.03538-0


lingua: Inglese

Comparative evaluation between B-mode ultrasonography and fluoroscopy guided pyelocalyceal access in percutaneous nephrolithotomy: a randomized clinical trial

Sasan MEHRABI 1, Shahriar AMIRHASSANI 1 , Mohammad A. AMIRZARGAR 1, Pouya PARSI 1, Sedigheh JOUGHEHDOUST 2, Seyed M. ZOLHAVARIEH 3

1 Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 2 Department of Engineering, Shahrood Branch, Islamic Azad University, Shahrood, Iran; 3 Department of Anesthesiology, Hamadan University of Medical Sciences, Hamadan, Iran


BACKGROUND: Minimizing X-ray exposure is a challenging subject during percutaneous nephrolithotomy. Ultrasonography is a good alternative to access creation in percutaneous nephrolithotomy. This study has compared B-mode ultrasonographic, and fluoroscopic access in percutaneous nephrolithotomy.
METHODS: In this trial 200 patients were enrolled who candidated for PCNL in Beheshti hospital in Hamedan, Iran. In 100 patients PCNL was done by B-mode ultrasonographic guided access (group 1) and in 100 patients it was done by fluoroscopic guided access (group2). The perioperative status such as success rate and surgery complications (i.e. bleeding, pyelocalyceal system perforation and adjacent organs injury) was evaluated. All operations were performed and scheduled by a single surgeon. All the statistical analyses were performed using the statistical package for the social science (SPSS Inc, Chicago, IL, USA) version 16.
RESULTS: No statistical difference was observed in sex, age, BMI, stone burden and location, degree of hydronephrosis in the groups. Duration of access was significantly shorter andduration of radiation exposure was meaningfully longer in fluoroscopic access compared to B-mode ultrasonography (P<0.001). The access success rate wassignificantly higher influoroscopic group than B-mode ultrasonographic group (P=0.001). No discrepancy was revealed in stone free rate between the procedures (84% in B-mode ultrasonographic accessand 86% influoroscopic access (P=0.89).
CONCLUSIONS: For minimizing X-ray exposure as a hazardous factor, using only ultrasonography or using it in combination with fluoroscopy in failed ultrasonographic access is feasible and safe with significantly lower x-ray exposure than onlyfluoroscopic access.

KEY WORDS: Kidney calculi - Ultrasonography - Nephrostomy, percutaneous - Fluoroscopy

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