Reducing Fluoroscopy Time in Percutaneous Nephrolithotomy

Sourial, Michael; Todd, Andrew; Palettas, Marilly; Knudsen, Bodo E.

doi:10.1089/end.2018.0837

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…When compared to previous studies, the average values compare favourably to some studies (stent insertion DAP, 49 Gy/cm 2 ; URS FT, 69.1 s), equivalent to others (PCNL FT, 364 s ), and less so to others (PCNL DAP, 4–4.52 Gy/cm 2 and FT, 33–240 s; URS DAP, 2.04 Gy/cm 2 ).…”

Section: Discussionsupporting

confidence: 54%

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

et al. 2019

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Objectives To define reference levels for intraoperative radiation during stent insertion, ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL); to identify variation in radiation exposure between individual hospitals across the UK, between low‐ and high‐volume PCNL centres, and between grade of lead surgeon. Patients/Subjects and Methods In all, 3651 patients were identified retrospectively across 12 UK hospitals over a 1‐year period. Radiation exposure was defined in terms of total fluoroscopy time (FT) and dose area product (DAP). The 75th percentiles of median values for each hospital were used to define reference levels for each procedure. Results Reference levels: ureteric stent insertion/replacement (DAP, 2.3 Gy/cm2; FT, 49 s); URS (DAP, 2.8 Gy/cm2; FT, 57 s); PCNL (DAP, 24.1 Gy/cm2; FT, 431 s). Significant variations in the median DAP and FT were identified between individual centres for all procedures (P < 0.001). For PCNL, there was a statistically significant difference between DAP for low‐ (<50 cases/annum) and high‐volume centres (>50 cases/annum), at a median DAP of 15.0 Gy/cm2 vs 4.2 Gy/cm2 (P < 0.001). For stent procedures, the median DAP and FT differed significantly between grade of lead surgeon: Consultant (DAP, 2.17 Gy/cm2; FT, 41 s) vs Registrar (DAP, 1.38 Gy/cm2; FT, 26 s; P < 0.001). Conclusion This multicentre study is the largest of its kind. It provides the first national reference level to guide fluoroscopy use in urological procedures, thereby adding a quantitative and objective value to complement the principles of keeping radiation exposure ‘as low as reasonably achievable’. This snapshot of real‐time data shows significant variation around the country, as well as significant differences between low‐ and high‐volume centres for PCNL, and grade of lead surgeon for stent procedures.

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Section: Discussionsupporting

confidence: 54%

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

et al. 2019

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“…In detail, 11 studies were about radiation exposure and associated harms [ [3] , [4] , [5] , [6] , [7] , [8] , 10 , 11 , [14] , [15] , [16] ]; 19 studies analyzed data on flexible or semirigid URS [ 18 , 19 , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] ]; nine studies assessed factors that affect radiation exposure during PCNL [ [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]; 21 studies evaluated several methods of renal puncture and their effect on radiation [ [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ]; two studies reported outcomes on tract dilation [ 68 , 69 ] and another two protocols for reduction of radiation during the whole procedure [ 70 , 71 ]. Regarding general measures that should ...…”

Section: Resultsmentioning

confidence: 99%

Radiation protection measures during endourological therapies

Tzelves

Juliebø-Jones

Manolitsis

et al. 2023

Asian Journal of Urology

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“…In the patients with high BMI and severe IHD, there are high risks for developing hemodynamic instability and difficult ventilation in prone position during mini PCNL and with the advent of newer techniques in endourology open surgery seems very unrealistic unless it is the last resort. 20,21 We found lateral decubitus position ideal for PCNL in such patients where cardiopulmonary stress is thought to be poorly tolerated. It is the most convenient position in cases with severe kyphosis, when prone or supine positions are not an option as demonstrated by Gofrit et al, 22 and other researchers.…”

Section: Discussionmentioning

confidence: 98%

Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study

Khizar

Nawaz

Shehzad

et al. 2022

PAFMJ

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Objective: To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy with fluoroscopy aided renal access in the lateral position, in patients who were high-risk cases for anesthesia in prone position. Study Design: Prospective observational study. Place and Duration of Study: Armed forces institute of Urology, Rawalpindi, from Jan 2018 to Dec 2019. Methodology: Fifty-three patients with renal stones >1.8cm underwent minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral position. All the patients were obese, some had severe ischemic heart disease, few had diabetes mellitus. All the patients were unfit for the prone position. Results: Successful renal access was achieved in all the patients (100%). The mean size of stone was 28 + 13.2 mm, with an average operative time being 55 ± 13.56 minutes and the mean hospital stay was 1.8 ± 2.3 days (range 2-4 days). No visceral or pleural injuries were documented. In addition, only two patients required postoperative transfusion. After procedure, the rate of complete stone clearance initially was 90.6%, which improved to 96% after single session of extracorporeal shockwave lithotripsy (ESWL). Only 2 (3.77%) patients had persistent residual stone fragment. Conclusion: Minimally invasive percutaneous nephrolithotomy with fluoroscopy-guided renal access in the lateral decubitus flank position, is safe and convenient in high-risk patients where prone position is contraindicated.

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Reducing Fluoroscopy Time in Percutaneous Nephrolithotomy

Cited by 10 publications

References 24 publications

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study

Radiation protection measures during endourological therapies

Safety of Minimally Invasive Percutaneous Nephrolithotmy in High Risk Patients in Lateral Position - A Single Center Study

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