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Ultrasound guided PCNL as good as conventional PCNL for nephrolithiasis

10 Jun 2019

Performing ultrasound-guided percutaneous nephrolithotomy (US-PCNL) either in prone or supine position is safe and effective as conventional PCNL, with the added benefit of eliminating radiation exposure and its hazards, according to a recent study.

The study randomized 392 consecutive patients (average age, 39 years; 68.88 percent male) with nephrolithiasis >2 cm to undergo ultrasound PCNL in either prone (P-US-PCNL; n=132) or supine (S-US-PCNL; n=129) or conventional PCNL (C-PCNL; n=131). Researchers recorded the preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities and stone-free rate.

Stone diameter did not significantly differ among the three treatment groups (mean, 31.2 mm in P-US-PCNL; 32.2 mm in S-US-PCNL and 33.6 mm in C-PCNL; p=0.116), neither did stone density (mean, 861, 915 and 900 HU, respectively; p=0.201).

The mean number of attempts and time for successful puncture were 1.9 and 15.8 sec in P-US-PCNL, 2.3 and 19.3 sec in S-US-PCNL, and 1.7 and 16.5 in C-PCNL (p<0.001). The mean operation time was 69, 75 and 72 minutes, respectively (p>0.05).

The mean nephrostomy time was comparable across the three treatment groups (3, 3.4 and 3.2 hours), as was the mean length of hospital stay (3.8, 4.1 and 3.9 days; p>0.05). Overall stone clearance rates were 88 percent with P-US-PCNL, 79 percent with S-US-PCNL and 85 percent with C-PCNL (p>0.05).

However, the mean percentage decrease in haemoglobin concentration was greater in the two US-PCNL groups vs C-PCNL (mean, 1.65, 1.77 and 2.1, respectively; p<0.001).

Complications were acceptable and similar between groups.

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