Assessing radiation exposure during endoscopic-guided percutaneous nephrolithotomy

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) may be associated with significant ionizing radiation exposure for patients and operating room staff. Endoscopic-guided PCNL (ePCNL) is a technique that may be associated with less radiation exposure. This study examines ePCNL-related radiation exposure (fluoroscopy time, effective dose) and investigates variables that may predict increased exposure. Methods: A retrospective review of all consecutive ePCNLs performed at our institution, by a single surgeon, was conducted between November 2011 and November 2013. Patient demographics, stone characteristics and perioperative details were recorded, including radiation exposure. Pearson and Spearman correlation were used to assess variables correlated with radiation exposure. Results: In total, 55 ePCNL cases were included in the study. The mean age was 60 ± 15 years, mean body mass index (BMI) 30.0 ± 6.4 kg/m 2 and mean stone size 3.2 × 2.1 cm. Seven cases (13%) involved complete staghorn stones, and 69% involved supracostal punctures. The mean fluoroscopy time was 3.4 ± 2.3 minutes, mean ED 2.4 ± 1.9 mSv. The treatment success rate, assessed 1-week postoperatively, was 87.3% and 7.3% of cases required ancillary procedures. The overall complication rate was 29%, but only 3 cases (5.5%) were Clavien ≥3. Longer fluoroscopy time correlated with increased stone size (p < 0.01), longer operative time (p < 0.01) and lower treatment success rates (p < 0.01); higher effective dose correlated with longer fluoroscopy time (p < 0.01) and increased skin-to-stone distance (p < 0.01). BMI did not correlate with fluoroscopy time or effective dose. Conclusions: Outcomes of ePCNL are comparable to traditional PCNL techniques and may be associated with lower radiation exposure, particularly beneficial for patients with higher BMI.

Ultrasound Guidance for Renal Tract Access and Dilation Reduces Radiation Exposure during Percutaneous Nephrolithotomy

“…After positioning the ureteroscope in the target calyx of choice, fluoroscopy is used to guide a needle into the kidney in an antegrade percutaneous fashion and the needle enters the collecting system under direct vision of the ureteroscope. It can be performed either in a modified supine [ 18 ] or prone split-leg position [ 19 , 20 ]. Once a target calyx is identified by flexible ureterorenoscopy, fluoroscopy is still needed for caliceal puncture.…”

“…Once a target calyx is identified by flexible ureterorenoscopy, fluoroscopy is still needed for caliceal puncture. Compared to standard PCNL, however, this technique can be associated with lower fluoroscopic screening time and increased stone clearance [ 19 , 21 ].…”

Does the presence of a percutaneous renal access influence fluoroscopy time during percutaneous nephrolithotomy?

“…Using visual and tactile cues, fixed lower mAs and kVp, a designated fluoroscopy technician on a laser-guided C-arm, and pulsed fluoroscopy at 1 frame per second was associated with 80.9% reduction in FT during PCNLs (175.6 vs. 33.7 s; p < 0.001) [15] . Finally, endoscopic-guided PCA has been recently described to be associated with significantly lower FT during PCNL [16] , [17] .…”

Biomarkers for Precision Urothelial Carcinoma Diagnosis: Current Approaches and the Application of Single-Cell Technologies

“…The BTA-TRAK and BTA-stat kits have a sensitivity of around 65% and specificity of 74–77% [ 13 , 52 ]. A meta-analysis of 13 studies that reviewed 3175 patients found the sensitivity and specificity of the BTA-stat kit to be 64–69% and 73–77%, respectively [ 9 ]. However, the studies included in this meta-analysis mainly compared individuals with high-grade UC with control groups.…”