Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis

Abstract

Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared.

Which Is the Preferred Modality of Renal Access for a Trainee Urologist: Ultrasonography or Fluoroscopy? Results of a Prospective Randomized Trial

“…Although statistically insignificant, the CROES study shows a lower incidence of pelvic perforation in the US group (2.9% vs 4%, p = 0.460). 20 They also reported on univariate analysis that US guidance was associated with lower postoperative hemorrhage (6% vs 13.1%, p = 0.001), although on further multivariate analysis, this difference was correlated to a larger access sheath use and multiple renal punctures ( p = 0.005, p = 0.046, respectively). 20 Additionally, the blood transfusion rate was lower in the US group (3.8% vs 11.1%, p < 0.001).…”

Use of Volume Rendered, Maximum Intensity Projection Images to Assess Whether the Medial Calyx Synonymous with the Posterior Calyx

“…During the course of the study, we were convinced that the future of PCNL access lies in 3-dimensional imaging. Authors have reported the feasibility of both ultrasound and CT guided punctures [10,11]. Until these modalities come into common use, the debate on the calyx of choice will remain relevant.…”

Ultrasound-Guided Renal Access for Percutaneous Nephrolithotomy: A Description of Three Novel Ultrasound-Guided Needle Techniques

“…4,9 One case-matched study comparing outcomes of ultrasoundand fluoroscopy-guided PCNL in 5806 patients found that postoperative hemorrhage and blood transfusion rates were significantly higher in the fluoroscopy group (11.1% vs 3.8%, p = 0.001), although they noted the use of larger access sheaths in the fluoroscopy group (22.6F vs 29.5F, p < -0.001) and longer hospital stays in the ultrasound group (5.3 vs 3.5 days, p < 0.001). 10 Utilizing ultrasound to achieve percutaneous renal access for PCNL has been established as safe and effective, with excellent clinical outcomes. Used in combination, ultrasound and fluoroscopy during PCNL can achieve comparable clinical outcomes and stone-free rates relative to fluoroscopy alone.…”