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Percutaneous nephrolithotomy with ultrasound-assisted puncture: does the technique reduce dependence on fluoroscopic ionizing radiation?

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Abstract

Purpose

The ultrasound-guided (US) puncture in percutaneous nephrolithotomy (PCNL) has demonstrated advantages over traditional fluoroscopy access. The aim of this study was to demonstrate the reduction of fluoroscopy time using this technique during PCNL as the surgeon gained experience.

Methods

Transversal study performed on 30 consecutive patients undergoing PCNL from March to November 2019. All punctures were performed with US guidance. The patients were divided into 2 groups of 15 each according to the chronological order of the intervention. Demographic data, preoperative parameters, puncture time, fluoroscopy time, stone-free rate and complications were analyzed.

Results

The time of fluoroscopy was considerably reduced as the experience in the number of cases increased, reducing from 83.09 ± 47.8 s in group 1 to 22.8 ± 10.3 s in group 2 (p < 0.01), the time required to perform the puncture was reduced of 108.1 ± 68.9 s in group 1, to 92.6 ± 94.7 s in group 2 (p < 0.67). Stone free rate of 83.3% was obtained globally.

Conclusion

US percutaneous renal access is safe and reproducible technique; the main advantage is to reduce exposure to radiation without compromising clinical results and has a short learning curve for urologists with prior experience in PCNL.

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References

  1. Patel SR, Nakada SY (2015) The modern history and evolution of percutaneous nephrolithotomy. J Endourol 29:153–157. https://doi.org/10.1089/end.2014.0287

    Article  PubMed  Google Scholar 

  2. Türk C, Neisius A, Petřík A et al (2020) EAU guidelines on urolithiasis 2020. Eur Assoc Urol Guidel 2020 Ed presented

  3. Iordache A, Baston C, Silviu-Stelian G-M et al (2018) Ultrasound for kidney access in percutaneous nephrolithotomy: a contemporary review. Med Ultrason 20:508. https://doi.org/10.11152/mu-1618

    Article  PubMed  Google Scholar 

  4. Usawachintachit M, Masic S, Allen IE et al (2016) Adopting ultrasound guidance for prone percutaneous nephrolithotomy: evaluating the learning curve for the experienced surgeon. J Endourol 30:856–863. https://doi.org/10.1089/end.2016.0241

    Article  PubMed  PubMed Central  Google Scholar 

  5. Wenzl TB (2005) Increased brain cancer risk in physicians with high radiation exposure. Radiology 235:709–711. https://doi.org/10.1148/radiol.2352041787

    Article  PubMed  Google Scholar 

  6. Linet MS, Freedman DM, Mohan AK et al (2005) Incidence of haematopoietic malignancies in US radiologic technologists. Occup Environ Med 62:861–867. https://doi.org/10.1136/oem.2005.020826

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ng FC, Yam WL, Lim TYB et al (2017) Ultrasound-guided percutaneous nephrolithotomy: advantages and limitations. Investig Clin Urol 58:346–352. https://doi.org/10.4111/icu.2017.58.5.346

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chu C, Masic S, Usawachintachit M et al (2016) Ultrasound-guided renal access for percutaneous nephrolithotomy: a description of three novel ultrasound-guided needle techniques. J Endourol 30:153–158. https://doi.org/10.1089/end.2015.0185

    Article  PubMed  PubMed Central  Google Scholar 

  9. Inoue T, Okada S, Hamamoto S et al (2018) Current trends and pitfalls in endoscopic treatment of urolithiasis. Int J Urol 25:121–133. https://doi.org/10.1111/iju.13491

    Article  PubMed  Google Scholar 

  10. Alcaraz-Gutiérrez M, Pulido-Contreras E, García-Padilla MA et al (2018) Experience of the first fifty percutaneous nephrolithotomies performed at a Mexican medical center. Rev Mex Urol 78:28–33. https://doi.org/10.24245/revmexurol.v78i1.1630

    Article  Google Scholar 

  11. Andonian S, Scoffone CM, Louie MK et al (2013) does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 27:24–28. https://doi.org/10.1089/end.2012.0347

    Article  PubMed  Google Scholar 

  12. Simmons J, Fulgham PF (2013) Renal ultrasound. In: Fulgham PF, Gilbert BR (eds) Practical urological ultrasound. Springer, New York, pp 47–69

    Chapter  Google Scholar 

  13. Desai M (2009) Ultrasonography-guided punctures—with and without puncture guide. J Endourol 23:1641–1643. https://doi.org/10.1089/end.2009.1530

    Article  PubMed  Google Scholar 

  14. Gupta S, Gulati M, Suri S (1998) Ultrasound-guided percutaneous nephrostomy in non-dilated pelvicaliceal system. J Clin Ultrasound 26:177–179. https://doi.org/10.1002/(SICI)1097-0096(199803/04)26:3%3c177::AID-JCU13%3e3.0.CO;2-8

    Article  CAS  PubMed  Google Scholar 

  15. Häcker A, Wendt-Nordahl G, Honeck P et al (2007) A biological model to teach percutaneous nephrolithotomy technique with ultrasound- and fluoroscopy-guided access. J Endourol 21:545–550. https://doi.org/10.1089/end.2006.0327

    Article  PubMed  Google Scholar 

  16. Bayne DB, Usawachintachit M, Tzou D et al (2018) Increasing body mass index steepens the learning curve for ultrasound-guided percutaneous nephrolithotomy. Urology 120:68–73. https://doi.org/10.1016/j.urology.2018.07.033

    Article  PubMed  Google Scholar 

  17. Song Y, Ma YN, Song YS, Fei X (2015) Evaluating the learning curve for percutaneous nephrolithotomy under total ultrasound guidance. PLoS ONE. https://doi.org/10.1371/journal.pone.0132986

    Article  PubMed  PubMed Central  Google Scholar 

  18. Allen D, O’Brien T, Tiptaft R, Glass J (2005) Defining the learning curve for percutaneous nephrolithotomy. J Endourol 19:279–282. https://doi.org/10.1089/end.2005.19.279

    Article  PubMed  Google Scholar 

  19. Liu Q, Zhou L, Cai X et al (2017) Fluoroscopy versus ultrasound for image guidance during percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 45:481–487. https://doi.org/10.1007/s00240-016-0934-1

    Article  PubMed  Google Scholar 

  20. Inanloo SH, Yahyazadeh SR, Rashidi S et al (2018) Feasibility and safety of ultrasonography guidance and flank position during percutaneous nephrolithotomy. J Urol 200:195–201. https://doi.org/10.1016/j.juro.2018.02.074

    Article  PubMed  Google Scholar 

  21. Falahatkar S, Neiroomand H, Enshaei A et al (2010) Totally ultrasound versus fluoroscopically guided complete supine percutaneous nephrolithotripsy: a first report. J Endourol 24:1421–1426. https://doi.org/10.1089/end.2009.0407

    Article  PubMed  Google Scholar 

  22. Li JX, Xiao B, Hu WG et al (2014) Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8 025 cases in China. Chin Med J 127:4184–4189. https://doi.org/10.3760/cma.j.issn.0366-6999.20141447

    Article  PubMed  Google Scholar 

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Urology Department, Unidad Medica de Alta Especialidad No. 1 Bajio, Instituto Mexicano del Seguro Social (IMSS), Lopez Mateos S/N., 37320, Leon, Guanajuato, Mexico

    Enrique Pulido-Contreras, Miguel Angel Garcia-Padilla, Javier Medrano-Sanchez & Miguel Angel Primo-Rivera

  2. Delegación del Instituto Mexicano del Seguro Social (IMSS), Coordinación de Planeación y Enlace Institucional, Leon, Guanajuato, Mexico

    Guadalupe Leon-Verdin

  3. University of California-San Diego School of Medicine, San Diego, CA, USA

    Roger L. Sur

Authors
  1. Enrique Pulido-Contreras
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  2. Miguel Angel Garcia-Padilla
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  3. Javier Medrano-Sanchez
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  4. Guadalupe Leon-Verdin
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  5. Miguel Angel Primo-Rivera
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  6. Roger L. Sur
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Contributions

EP-C: protocol development, project development, data collection, manuscript writing, and manuscript editing. MAG-P: project development, manuscript writing, and manuscript editing. JM-S: project development and manuscript writing. MGL-V: data analysis and table design. MAP-R: data collection. RLS: project development and critical revision of the manuscript.

Corresponding author

Correspondence to Enrique Pulido-Contreras.

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Conflict of interest

On the part of the authors, no conflict of interest are declared.

Ethical approval

This study was conducted collecting data obtained for clinical purposes and all the procedures were performed as part of the routine care. Then, our study did not need ethical approval. The procedures used in this study adhere to the principles of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study prior to the procedures.

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Pulido-Contreras, E., Garcia-Padilla, M.A., Medrano-Sanchez, J. et al. Percutaneous nephrolithotomy with ultrasound-assisted puncture: does the technique reduce dependence on fluoroscopic ionizing radiation?. World J Urol 39, 3579–3585 (2021). https://doi.org/10.1007/s00345-021-03636-2

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  • DOI: https://doi.org/10.1007/s00345-021-03636-2

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