Ultrasonographic versus Fluoroscopic Access for Percutaneous Nephrolithotomy: A Meta-Analysis

Abstract

Objective: To assess the safety and efficacy of ultrasonographic vs. fluoroscopic access for percutaneous nephrolithotomy (PCNL). Methods: Medline (PubMed), Embase, Ovid, Cochrane, and the Chinese Biomedical Literature databases were searched to identify clinically controlled trials (CCTs) and randomized controlled trials (RCTs) that compared ultrasonographic access with fluoroscopic access for PCNL. RevMan 5.1 software and Stat Manager V4.1 software were used for the meta-analysis. Results: Five RCTs and nine CCTs were included in our study, which contained a total of 3,019 patients. Of these, 1,574 (52%) had undergone ultrasonographic access, and 1,445 (48%) had undergone fluoroscopic access. The pooled results revealed that the ultrasonographic access patients had shorter duration of access (min) by 2.56 min (weighted mean difference (WMD) = −2.56, 95% confidence interval (CI): −4.40 to −0.72, p = 0.006). There was a higher stone-free rate in the ultrasonographic access group (odds ratio (OR) = 1.26, 95% CI: 1.02-1.55, p = 0.03), as well as a lower rate of operative complications (OR = 0.72, 95% CI: 0.56-0.93, p = 0.01), reduced intraoperative blood loss (ml) (WMD = −14.55 ml, 95% CI: −27.65 to −1.46, p = 0.03), and a lower rate of blood transfusion requirement (OR = 0.39, 95% CI: 0.24-0.63, p = 0.0001). Sensitivity and subgroup analyses were also performed. Conclusion: Except for no radiation exposure, our meta-analysis revealed that ultrasonographic access had many advantages, such as a shorter access time, reduced intraoperative blood loss, a lower rate of operative complications, a lower rate of blood transfusion, and a higher stone-free rate. Because of these significant advantages, we recommend the use of ultrasonographic access for PCNL.

Effect of Obesity on Outcomes of Percutaneous Nephrolithotomy in Renal Stone Management: A Systematic Review and Meta-Analysis

“…RIRS is a safe and effective approach for renal stone treatment in obese individuals, except that RIRS requires long operation time depending on the size, number, and location of stones and on the experience of the surgeon [9] . PCNL is the gold standard first-line treatment for renal stones larger than 2 cm; the use of ultrasonographic access is recommended for PCNL [10] . PCNL is a particularly important therapeutic modality for obese individuals.…”

Comparing Bleeding Complications of Double and Single Access Totally Tubeless PCNL: Is It Safe to Obtain More Accesses?

“…To avoid multiple admissions, surgical procedures, related psychiatric stress and economic cost, some urologists prefer to manage some patients with multiple accesses specially that it has been demonstrated that blood loss and complication rates of the two approaches are comparable [18]. Although Akman and colleagues indicated significant bleeding in multiple-access PCNL, they showed that multi-access PCNL is a highly successful alternative to the single-access approach [17,19,20,21]; nonetheless, none of them have left the patient totally tubeless after multiple accesses.…”

Predicting Outcomes after Minimally Percutaneous Nephrolithotomy with the Aid of a Patented System by Using the Guy's Stone Score

“…A 5 F ureteral catheter was then inserted retrogradely into the renal pelvis through cystoscopy or flexible ureteroscopy (URS), and continuous infusion of saline was performed to produce artificial hydronephrosis. The patient was then changed to the prone position [5,6,8]. …”

“…Ultrasound-guided percutaneous punctures were made with an 18-gauge coaxial needle into the targeted calix (middle/lower kidney calices) [5,6,8]. The puncture point was in the 12th rib infracostal margin, between the posterior axillary line and scapula line [9].…”