Presentation Authors: Ahmet Sahan, Asgar Garayev, Berkan Simsek, Cengiz Canakcı, Bilal Eryildirim, Yiloren Tanidir*, Istanbul, Turkey
Introduction: Upper calyx access in percutaneous nephrolithotomy (PCNL) is an effective route to achieve access to the whole collecting system in complex kidney stone case or in high stone burden. However, it is less preferred or underutilized due to the previously reported high complication rates. Some studies suggest ultrasound to be superior in access upper calyx access. Present study compares the safety and efficiency of ultrasonography-guided versus fluoroscopy-guided upper calyx access in PCNL
Methods: In total, all consecutive PCNL cases in two different institutions were reviewed from 2015 to 2017. Patients with solitary upper calyx access were enrolled into the study. In total 143 patients were recruited into the study. Patients were divided into two groups according to the coupling imaging in access: fluoroscopy-guided (institution A) (n=85) and ultrasonography-guided (institution B) (n=58). Preoperative patients and stone demographics, and complication rates are compared (Table 1-2).
Results: Patients and stone characteristics were almost similar in each group (Table 1). However, the stone density was higher in group 1 and they also had high number of multiple stone cases. Both groups complications rates were similar according to the modified Clavien-Dindo Grading System (p>0.05). Fluoroscopy-guided PCNL was similar to ultrasonography-guided PCNL in terms of pleural invasion (9.4 % vs 5.2%), blood transfusion (8.2% vs 12.1%), extravasation requiring DJ insertion (4.7% vs 3.4%) and urinary tract infection ((14.1 % vs 15.5 %) (p>0.05). Fluoroscopy was also used in the control of residual stones in ultrasonography-guided PCNL cases, but the duration of total fluoroscopy and duration of operation were significantly shorter in group 2.
Conclusions: The complications rates in ultrasound coupled PCNL is not better than the ones in fluoroscopy-guided. However, operation time gets shorter and fluoroscopy use decreases with similar stone free rates in ultrasonography-guided PCNL.