Doppler Ultrasound-guided Percutaneous Nephrolithotomy: A Prospective Randomized Study

OBJECTIVE To evaluate the role, safety, and effectiveness of Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL). METHODS The present study was a prospectively randomized controlled trial performed from March 2007 to February 2010. A total of 131 patients, scheduled for PCNL to remove huge renal stones (diameter >35 mm) and staghorn stones, were enrolled and prospectively randomized using a random numbers table into 2 groups. Of the 131 patients, 54 were randomized to ultrasound-guided puncture PCNL (group 1). Group 2 included 57 patients who received Doppler ultrasound-guided PCNL. A total of 30 patients were excluded from the study. The preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography, and technetium-99m diethylenetriaminepentaacetic acid to determine the selective glomerular filtration rate. The intraoperative findings, operative time (from insertion of the puncture needle to the end of the procedure), and outcomes were also recorded. The complete blood count and serum creatinine were also checked. The modified Clavien grading system was used to evaluate the perioperative morbidity of PCNL. RESULTS No difference was found between the 2 groups with regard to the serum creatinine change, length of stay, return to normal activity, Clavien grade, relative perfusion rate, or glomerular filtration rate, as determined by technetium-99m diethylenetriaminepentaacetic acid clearance, preoperatively and postoperatively. However, the hemoglobin decrease (2.33 +/- 0.46 g/dL) in the ultrasound-guided puncture group was greater than that in the Doppler ultrasound-guided group, with statistically significant difference. CONCLUSION Doppler ultrasound-guided PCNL is accurate and safe and was associated with less blood loss. We believe that Doppler ultrasound can be an important alternative to B-mode ultrasound guidance. UROLOGY 78: 535-539, 2011. Crown Copyright (C) 2011 Published by Elsevier Inc.