Comparative evaluation between B-mode ultrasonography and fluoroscopy guided pyelocalyceal access in percutaneous nephrolithotomy: a randomized clinical trial

BACKGROUND: Minimizing X-ray exposure is a challenging subject during percutaneous nephrolithotomy. Ultrasonography is a good alternative to access creation in percutaneous nephrolithotomy. This study has compared B-mode ultrasonographic, and fluoroscopic access in percutaneous nephrolithotomy. METHODS: In this trial 200 patients were enrolled who candidated for PCNL in Beheshti hospital in Hamedan, Iran. In 100 patients PCNI, was done by B-mode ultrasonographic guided access (group 1) and in 100 patients it was done by fluoroscopic guided access (group2). The perioperative status such as success rate and surgery) , complications (i.e. bleeding, pyelocalyceal system perforation and adjacent organs injury) was evaluated. All operations were performed and scheduled by a single surgeon. All the statistical analyses were performed using the statistical package for the social science (SPSS Inc, Chicago, IL, USA) version 16. RESULTS: No statistical difference was observed in sex, age, BMI, stone burden and location, degree of hydronephrosis in the groups. Duration of access was significantly shorter and duration of radiation exposure was meaningfully longer in fluoroscopic access compared to B-mode ultrasonography (P<0.001). The access success rate was significantly higher influoroscopic group than B-mode ultrasonographic group (P=0.001). No discrepancy was revealed in stone free rate between the procedures (84% in B-mode ultrasonographic access and 86% influoroscopic access (P=0.89). CONCLUSIONS: For minimizing X-ray exposure as a hazardous factor, using only ultrasonography or using it in combination with fluoroscopy in failed ultrasonographic access is feasible and safe with significantly lower x-ray exposure than only fluoroscopic access.