X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical
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UROLOGY - ORIGINAL PAPER
X‑ray‑free ultrasound‑guided versus fluoroscopy‑guided percutaneous nephrolithotomy: a comparative study with historical control Ponco Birowo1 · Putu Angga Risky Raharja1 · Harun Wijanarko Kusuma Putra1 · Reginald Rustandi1 · Widi Atmoko1 · Nur Rasyid1 Received: 26 May 2020 / Accepted: 14 July 2020 © The Author(s) 2020
Abstract Purpose To compare the outcomes and complications of supine X-ray-free ultrasound-guided percutaneous nephrolithotomy (XG-PCNL) with fluoroscopy-guided (FG)-PCNL in both prone and supine positions. Methods This was a comparative study that included a prospective cohort and historical control groups. This study analysed 40 consecutive patients who undergone supine XG-PCNL between October 2019 and March 2020. The control groups were composed of historical control formed from the last 40 consecutive patients who underwent FG-PCNL in both supine and prone positions from our PCNL database from January 2018 and September 2019. Patients’ demographics, stone characteristics and intraoperative and postoperative outcomes were compared. Results A total of 120 patients were classified into the supine XG-PCNL, supine FG-PCNL, and prone FG-PCNL groups (each N = 40). They had similar baseline characteristics and initial stone burden. The supine XG-PCNL group had higher puncture attempts, nephrostomy tube placement, and longer surgery duration than both the supine and prone FG-PCNL groups. However, the stone-free rate was similar in all groups (85%, supine XG-PCNL; 72.5%, supine FG-PCNL; 77.5% prone FG-PCNL; p = 0.39). No significant difference was found in the complication rate and length of stay among the three groups. Conclusion Supine XG-PCNL is an alternative to both supine and prone FG-PCNL with similar efficacy and complication rates for kidney stone patients. This could be a good alternative to urological centres with no access to fluoroscopy. Keywords Percutaneous nephrolithotomy · Supine · Ultrasound-guided · X-ray-free
Introduction Percutaneous nephrolithotomy (PCNL) is currently the leading minimally invasive procedure to remove large (i.e., > 20 mm) or complex kidney stones [1,2]. PCNL is conventionally assisted by fluoroscopy, however, it may present radiation exposure risk to both the patient and surgical team [3]. Thus, X-ray-free ultrasound-guided (XG)PCNL was developed with the focus on decreasing radiation risks while sustaining real-time control during percutaneous access [4]. The use of XG-PCNL could also increase the number of provided PCNL procedures especially in the * Ponco Birowo [email protected] 1
Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta 10430, Indonesia
peripheral area, given the higher rate of ultrasound device availability in most peripheral hospitals. The total cost for every case of XG-PCNL was also approximately 30% less than the fluoroscopy-guided (FG)-PCNL [5]. Furthermore, the prone position has been the preferred method for establishing percutaneous acces
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