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Ultrasound-guided X-ray free percutaneous nephrolithotomy for treatment of simple stones in the flank position. | LitMetric

Ultrasound-guided X-ray free percutaneous nephrolithotomy for treatment of simple stones in the flank position.

Urol Res

Department of Urology, Medicine Faculty, Canakkale Onsekiz Mart University, Barbaros mh Umit Serdaroglu cd, Hasret Sit. A1 Blok d:13, Canakkale/Merkez, Turkey.

Published: June 2011

AI Article Synopsis

  • The study evaluated the safety and effectiveness of performing percutaneous nephrolithotomy (PCNL) using ultrasound guidance in the flank position, bypassing the need for fluoroscopy, on 43 patients with kidney stones larger than 20 mm.
  • Complete access to the targeted calyx was achieved in all cases, with an overall stone-free rate of 86.1%, and no major complications were observed during or after surgery.
  • This ultrasound-guided approach is suggested to be a safer method compared to traditional techniques, though it is recommended for select cases with a limited number of large stones and simpler kidney anatomy, while also providing more comfort for patients during the procedure.

Article Abstract

The purpose of this study was to examine the effectiveness and safety of percutaneous nephrolithotomy with ultrasonography-guided renal access in the flank position without the use of fluoroscopy in any stage of the procedure. Percutaneous nephrolithotomy was performed in flank position under the guidance of ultrasound (USG) without the use of fluoroscopy between December 2008 and January 2010 on 43 patients who had kidney stones bigger than 20 mm. Access to the kidney's proper calyx was achieved by dilatation through the guide wire placed after insertion of the needle through the needle director under the guidance of transrectal ultrasound probe placed on the patient's flank area. A convex USG probe was used for imaging during dilatation and lithotripsy instead of fluoroscopy. Access to the targeted calyx was achieved successfully in all patients (100%). The percentage stone free rate was 86.1% (37 patients). Residual stones were detected in six patients. Their dimensions ranged from 5 to 12 mm. The mean stone diameter was 29 (20-41) mm, duration of surgery was 87.1 ± 43.2 (55-210) min and duration of hospital stay was 3.1 (2-8) days. Blood transfusions were given to two patients; none of the patients had major intraoperative or postoperative complications. In comparison with standard percutaneous nephrolithotomy, percutaneous nephrolithotomy in flank position under ultrasonographic imaging instead of using fluoroscopy seems to be safe and effective. This procedure has to be limited to selected cases with one or maximum two big stones in the pelvis or in a single calyx in absence of complex intrarenal anatomy. Both surgical team and the patients were protected from the harmful effects of radiation. Regarding anesthesia, flank position is more comfortable for the patient than prone position.

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Source
http://dx.doi.org/10.1007/s00240-010-0336-8DOI Listing

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