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Percutaneous Nephrolithotomy, Extracorporeal Shockwave Lithotripsy, Medical Expulsive Therapy
Background: Renal stone is one of the most common renal diseases worldwide. There are several modalities for treatment of renal stone disease, one of these modalities is the use of percutaneous nephrolithatomy (PCNL) surgery which can be done either under fluoroscopic or ultrasonic or even combined fluoroscopic and ultrasonic gaudiness. The purpose of this study is to compare the outcome of combined ultrasonic and fluoroscopic versus fluoroscopic guided PCNL.
Materials and Method: This is a prospective study done in AL Basrah teaching hospital from May 2015 to December 2019, 200 patients with the diagnosis of renal stone indicated for PCNL surgery and operated on in standard prone position. One hundred forty-eight patients were operated on using fluoroscopic guidance. The other 52 patients were operated on using combined ultrasonic and fluoroscopic guided PCNL. Statistical analysis for the results regarding the outcome and complication was done using SPSS 22 program.
Results: The mean BMI of the two groups was 28 in fluoroscopic group and 27.3 in the combined ultrasonic and fluoroscopic group (p=0.30). The mean stone burden was 21.5 and 24.4 in fluoroscopic and combined group, respectively (p=0.20). The stone free rate was 85.5% in fluoroscopic group and 88.5% in combined group, that was of no significance (p = 0.16). Overall 17 patients (11.4%) in fluoroscopic group and 5 patients (9.6%) of combined group had complications (p=0.11). Mean operative time in fluoroscopic group was 85 minutes, and in the combined group it was 78 minutes (p=0.39). Mean hospital stay was two days for both groups. There were no reported cases of visceral injury in both groups.
Conclusions: This study showed that patients treated by combined ultrasonic and fluoroscopic guided PCNL had the same outcomes of fluoroscopically guided PCNL with the advantage of lower time of radiation exposure in the combined group.
Abbreviations: PCS: Pelvi Calyceal System, US: Ultra Sound, CT: Computed Tomography, BMI: Body Mass Index, URS : Uretroscopy.
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