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Open Access Publications from the University of California

Ultrasound guidance can be used safely for renal tract dilation during percutaneous nephrolithotomy.

  • Author(s): Armas-Phan, Manuel
  • Tzou, David T
  • Bayne, David B
  • Wiener, Scott V
  • Stoller, Marshall L
  • Chi, Thomas
  • et al.

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OBJECTIVES:To compare clinical outcomes between patients who underwent percutaneous nephrolithotomy with renal tract dilation performed under fluoroscopic versus ultrasound guidance. PATIENTS AND METHODS:A prospective observational cohort study enrolled successive patients undergoing PCNL between July 2015 and March 2018. Included in this retrospective analysis were cases where renal puncture was successfully obtained with ultrasound guidance. Cases were then grouped according to whether fluoroscopy was used to guide renal tract dilation or not. All statistical analyses were performed on Stata version 15.1 including univariate (Fisher's exact test, Welch's t-test) and multivariate analyses (binomial logistic regression, ordinal logistic regression, and linear regression). RESULTS:176 patients underwent PCNL with successful ultrasound-guided renal puncture of which 38 and 138 underwent renal tract dilation with fluoroscopic versus ultrasound, respectively. There were no statistically significant differences in patient age, gender, body mass index, preoperative hydronephrosis, stone burden, procedure laterality, number of dilated tracts, and calyceal puncture location between the two groups. Among ultrasound tract dilations, a higher proportion of patients were positioned modified dorsal lithotomy as opposed to prone and a significantly lower operative time was seen. Only modified dorsal lithotomy remained statistically significant after multivariate regression. There were no statistically significant differences in postoperative stone clearance, complication rate, or intraoperative estimated blood loss. A 5-unit increase in a patient's body mass index was associated with 30% greater odds of increasingly severe Clavien-Dindo complications. A 5mm decrease in the preoperative stone burden was associated with 20% greater odds of stone-free status. No variables predicted estimated blood loss with statistical significance. CONCLUSIONS:Renal tract dilation can be safely performed in the absence of fluoroscopic guidance. Compared to using fluoroscopy, our study demonstrated that ultrasound dilations can be safely performed without higher complication or bleeding rates. This can be done using a variety of surgical positions, and future studies centered on improving dilation techniques could be of impactful clinical value. This article is protected by copyright. All rights reserved.

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