Air vs contrast pyelogram for initial puncture access in percutaneous nephrolithotomy: a randomized controlled trial

Gupta, Prateek K.; Choudhary, Gautam Ram; Pandey, Himanshu; Madduri, Vijay Kumar Sarma; Singh, Mahendra; Pallagani, Likhiteswer

doi:10.1007/s00240-020-01222-6

Cited by 2 publications

(4 citation statements)

References 22 publications

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“…Gupta et al reported statistically significant reductions in mean access time, radiation exposure, and puncture attempts in the group undergoing air contrast visualization. 19 Additionally, this study reported a greater stone-free rate in the air contrast group. Case reports have described venous air embolism as a rare, but potentially life-threatening, complication of air contrast retrograde pyelography.…”

Section: Air Contrast Pyelographymentioning

confidence: 57%

“…20 In their article, Gupta et al described measures taken to reduce the risk for air embolism, including positioning the head end of the patient at 15 , informing the anesthesia team when air was delivered, and delivering the air in a slow and gentle manner. 19 No cases of venous air embolism were observed. The safety of air pyelography was also studied by Ali Khan et al in a 2020 prospective study including 164 patients undergoing air pyelogram assisted access for PCNL.…”

Section: Air Contrast Pyelographymentioning

confidence: 96%

“…In a 2021 randomized controlled trial, Gupta et al compared PCNL procedures performed using air vs contrast for initial puncture in 122 patients. 19 In the air contrast group, room air was injected via a ureteral catheter under fluoroscopic guidance. The air was injected at 5-mL increments until adequate visualization of the pelvicalyceal system was obtained.…”

Section: Air Contrast Pyelographymentioning

confidence: 99%

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International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist

et al. 2023

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Introduction:In April 2022, GE Healthcare announced a COVID-19–related interruption in iohexol manufacturing, leading to an international iodinated contrast shortage. The shortage greatly impacted urological practice, highlighting the value of alternative contrast agents and imaging/procedure alternatives. These alternatives are reviewed in this work.Methods:A review of existing literature describing the use of alternative contrast agents, alternative imaging procedures, and contrast conservation strategies in urological care was performed using the PubMed database. The review was not performed systematically.Results:Older iodinated contrast agents such as ioxaglate and diatrizoate can replace iohexol for intravascular imaging in patients without renal impairment. These agents, along with gadolinium-based agents such as Gadavist, have been used intraluminally for urological procedures and diagnostic imaging. Several lesser-known imaging and procedure alternatives are described and include air contrast pyelography, contrast-enhanced ultrasound, voiding urosonography, and low tube voltage CT urography. Conservation strategies include contrast dose reductions and use of contrast management devices for contrast vial splitting.Conclusions:The COVID-19–related iohexol shortage caused significant hardship for urological care internationally, leading to delayed contrasted imaging studies and urological procedures. Alternative contrast agents, imaging/procedure alternatives, and conservation strategies are reviewed in this work with the goal of equipping the urologist to mitigate the current iodinated contrast shortage and to prepare in the event of a future shortage.

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Section: Air Contrast Pyelographymentioning

confidence: 57%

Section: Air Contrast Pyelographymentioning

confidence: 96%

Section: Air Contrast Pyelographymentioning

confidence: 99%

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International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist

et al. 2023

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“…Sometimes simple modifications achieve comparable improvements to high-tech solutions. In a RCT a retrograde air pyelogram instead of a contrast pyelogram improved fluoroscopy time, radiation dose, access time and number of puncture attempts compared to the conventional technique [29]. Performed antegrade, it could even save the time of retrograde manipulation [30].…”

Section: Fluoroscopymentioning

confidence: 99%

Percutaneous nephrolithotomy – the puncture

Alken

2021

BJU International

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ObjectiveTo determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. MethodsPubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. ResultsThe puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. ConclusionsThe importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

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Air vs contrast pyelogram for initial puncture access in percutaneous nephrolithotomy: a randomized controlled trial

Cited by 2 publications

References 22 publications

International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist

International Iohexol Shortage: Alternative Contrast Agents and Imaging Procedures for the Urologist

Percutaneous nephrolithotomy – the puncture

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