Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

Arenas, Javier; Baldwin, D. Duane

doi:10.1007/s11934-015-0517-7

Cited by 12 publications

(10 citation statements)

References 101 publications

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“…Tiene numerosos beneficios, pues brinda seguridad tanto para la madre como para el feto debido a la no exposición a radiación ionizante, es rápida y resulta fácilmente accesible en los centros de salud. La ecografía muestra el parénquima renal y el sistema pielocalicial, el uréter superior y parte del uréter inferior a través de la vejiga 19 ; sin embargo, un diagnóstico definitivo con ecografía puede ser difícil debido al hábito corporal de la paciente, la posición del feto o la ubicación de los cálculos dentro del uréter por el útero grávido 17,35,39 . La ecografía transvaginal puede aportar información valiosa, ya que evalúa mejor el uréter distal y la unión ureterovesical.…”

Section: Pruebas Diagnósticasunclassified

“…Su ventaja radica en que brinda la localización y la medición precisas del cálculo dentro del árbol urinario, y además es útil para el diagnóstico diferencial de patologías que cursan con la misma sintomatología 18,31 . No obstante, su mayor desventaja para la paciente gestante es la alta exposición del feto a la radiación; de hecho, este es el factor limitante más importante 3,39 . Como ya se ha mencionado, se ha demostrado que dosis de radiación menores de 50 mGy se asocian a un riesgo más bajo de malformaciones congénitas, retraso en el crecimiento intrauterino, efectos carcinogénicos y muerte fetal intrauterina 38 .…”

Section: Pruebas Diagnósticasunclassified

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Nefrolitiasis en la paciente gestante: revisión de la literatura

Bohórquez-Rivero¹,

Restom-Arrieta²,

Sáenz-López³

et al. 2024

RECHOG

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La litiasis renal en la paciente gestante es una condición relativamente infrecuente; sin embargo, es la causa más común de dolor no obstétrico durante el embarazo. En el periodo de gestación se producen diversos cambios anatomofisiológicos en el tracto urinario, como la dilatación de los cálices renales, la pelvis renal y los uréteres por causa del efecto que ejerce la progesterona sobre el músculo liso uretral, y la compresión de los uréteres por el útero grávido. Estas modificaciones conducen a un aumento del flujo plasmático renal y de la tasa de filtrado glomerular, ocasionando hiperuricosuria e hipercalciuria. Del mismo modo, durante el embarazo también se produce un aumento de la secreción de inhibidores de cálculos, por lo cual la prevalencia de la formación de cálculos durante el embarazo es similar a la de las mujeres no embarazadas. El bajo índice de sospecha por parte del médico tratante puede entorpecer el diagnóstico y el tratamiento de esta patología, que también son limitados en la gestación debido a los potenciales riesgos teratogénicos. Se realiza una revisión narrativa de la literatura partiendo de la evidencia científica disponible en las diferentes bases de datos y de esta manera se pretende instruir al médico en los aspectos clave de dicho tema.

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Section: Pruebas Diagnósticasunclassified

Nefrolitiasis en la paciente gestante: revisión de la literatura

Bohórquez-Rivero¹,

Restom-Arrieta²,

Sáenz-López³

et al. 2024

RECHOG

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“…21 In an effort to adhere to radiation safety principles such as ALARA (as low as reasonably achievable), intraoperative radiationreducing maneuvers during endourologic cases have been implemented. [22][23][24] It follows that perhaps the most obvious advantage of US-PCNL over F-PCNL is the reduction-or in some cases, complete elimination-of ionizing radiation exposure to the patient and members of the operating room (OR) team. Obese patients appear to experience the greatest reduction in ionizing radiation exposure and therefore may benefit most from US-PCNL.…”

Section: Cuaj -Techniques In Urologymentioning

confidence: 99%

Techniques ‒ Ultrasound-guided percutaneous nephrolithotomy: How we do it

Beiko¹,

Razvi²,

Bhojani³

et al. 2019

CUAJ

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Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists’ training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.

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“…Various technical and procedural modifications have been implemented intraoperatively to reduce fluoroscopy exposure to both urologists and patients, including proper shielding, low power fluoroscopy settings, and conservative use of fluoroscopy [ 1 ]. Although these measures significantly reduce radiation exposure to the operating room staff and patient, the surgeon’s hand remains susceptible to radiation exposure using these methods.…”

Section: Introductionmentioning

confidence: 99%

Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques

Chen,

Joo,

Baas

et al. 2024

Urolithiasis

Self Cite

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Percutaneous nephrolithotomy confers the highest radiation to the urologist’s hands compared to other urologic procedures. This study compares radiation exposure to the surgeon’s hand and patient’s body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon’s hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon’s hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey’s B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon’s hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.

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Techniques for Minimizing Radiation Exposure During Evaluation, Surgical Treatment, and Follow-up of Urinary Lithiasis

Cited by 12 publications

References 101 publications

Nefrolitiasis en la paciente gestante: revisión de la literatura

Nefrolitiasis en la paciente gestante: revisión de la literatura

Techniques ‒ Ultrasound-guided percutaneous nephrolithotomy: How we do it

Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques

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