Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy : A Randomized Clinical Trial

Achieving access to the pyelocaliceal system in percutaneous nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance. We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access. In a clinical trial, 100 patients with no abnormality of the upper urinary tract were selected from among candidates for PCNL and randomly assigned to two 50-patient groups: ultrasonography-guided access (group 1) versus fluoroscopy-guided access (group 2). In group 1, location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position. Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe. If access to the collecting system was achieved, the site of puncture was controlled using fluoroscopy. In group 2, access was achieved using fluoroscopy guidance. Tract dilatation and stone extraction were the same in both groups. The mean age of patients was 40.7 +/- 12 years and 41.6 +/- 13.7 years in groups 1 and 2, respectively (P = 0.4). The male to female ratio in groups 1 and 2 was 34/16 and 31/19, respectively (P = 0.5). On average, duration of access was 11 +/- 3.5 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively (P = 0.0001). Duration of radiation exposure, on average, was 0.69 +/- 0.26 minutes and 0.95 +/- 0.44 minutes in groups 1 and 2, respectively (P = 0.0001). Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards.