Can ultrasound guidance reduce radiation exposure significantly in percutaneous nephrolithotomy in pediatric patients?

Ilikan, Gülşah Bayram; Karabulut, Bilge; Tiryaki, Tuğrul

doi:10.1007/s00240-020-01241-3

Cited by 4 publications

(2 citation statements)

References 28 publications

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“…In the past, the PCNL puncture was done under the guidance of radiation; however, the surgeons and patients are exposed to radiation. According to the ICRP 60 report, the annual radiation dose for radiation workers is 20 mSv [ 22 , 23 ]. Previous studies have shown that the mean radiation dose received during PCNL surgery was 8.66 mSv [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy and its initial clinical application

Hong

Wang

et al. 2022

BMC Urol

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Background To assess the outcome of the mini-track, mini-nephroscopy, mini ultrasonic probe percutaneous nephrolithotomy for upper ureteral and kidney stones. Methods We collected data of 53 patients (55 kidney units) who underwent mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy between September 2020 and March 2021. The study included single and upper ureteral stones from 12 kidneys, multiple stones from 28 kidneys, and staghorn stones from 15 kidneys. Results The mean operative duration was 50.6 min, ranging from 15 to 200 min, whereas the mean lithotripsy and stone removal time was 17.2 min (3–45 min). Moreover, the mean postoperative length of stay was 4.0 days (1–7 days). Besides, the stone-free rate (SFR) of discharge was 89.1% (49/55). The mean hemoglobin drop was 15.3 mg/dL, ranging 1–32 mg/dL. Out of the total cases, only 4 of them displayed minor complications. The outcomes of < 40 mm versus ≥ 40 mm calculi were compared by performing subgroup analysis. The results demonstrated a longer operation duration (65.2 vs. 40.2 min), higher complication rate (13.0% vs. 3.3%), and lower SFR in the ≥ 40 mm calculi subgroup. Conclusions In summary, mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy is an effective and safe method to treat patients with upper ureteral and kidney calculi. This is especially significant for the stone size of 20–40 mm, demonstrating excellent SFR and a lower complication rate.

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Section: Discussionmentioning

confidence: 99%

Mini-track, mini-nephroscopy, mini-ultrasonic probe percutaneous nephrolithotomy and its initial clinical application

Hong

Wang

et al. 2022

BMC Urol

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“…It was quicker and more accurate, stone-free rates were better in the RAF group, needle puncture required fewer attempts, complications were fewer, and based on this initial study it would seem the RAF method is superior to the traditional US-guided method. The only advantages I can see for US guidance are less fluoroscopy time 2 and the (US) equipment is less costly.…”

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confidence: 99%

Editorial Comment

Noble

2022

Journal of Urology

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Renal access is the single most important step to completing a successful percutaneous nephrolithotomy (PCNL). Renal access obtained by a urologist is associated with increased stone-free rates, decreased complications, decreased length of stay and decreased hospital costs when compared to renal access obtained by a radiologist. 1e3 Data from U.S. insurance claims databases indicate that urologist-obtained access is on the rise, increasing from 13% in 2007 to 32% in 2017. 3 If urologistobtained access results in positive patient outcomes, why do the majority of urologists still rely on radiologists to obtain access for PCNL? A major barrier continues to be the learning curve. As the authors point out, techniques such as ultrasound guidance for access have decreased the learning curve compared to traditional fluoroscopy guidance, but even at less than 20 cases to learn ultrasound access, urologists experience variable training in obtaining access during residency/fellowship and thus do not uniformly finish their training feeling comfortable with obtaining their own access. Clearly there remains a clinical need to get us closer to 100% urologist-obtained access for PCNL.Robotic assistance may represent a solution for this clinical need. In this randomized, single-blind trial, the authors found a decreased number of needle punctures, decreased access time and increased success of trainees with robotic-assisted fluoroscopicguided vs ultrasound-guided renal access, with no difference in stone-free rates or complications between the groups. Pairing an artificial intelligence puncture trajectory finder with robotic-assisted needle access represents a novel advancement of technology. We often see new technologies with no clinical applicability. These results may represent an encouraging new potential avenue to increase urologist-obtained renal access with new technology matched to a clinical need.

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