Effective evaluation of using ultrasound-guided renal access for percutaneous nephrolithotomy

Purposes: To evaluate the effectiveness of using ultrasound-guided renal access for percutaneous nephrolithotomy (PCNL). Methods: Between January 2016 and April 2017, at Saint Paul hospital, 130 patients were treated, 88 men and 42 women, with a mean age of 52.4 +/- 11.5 years and a mean stone size of 30.82 +/- 11.47mm. All stones were located in the renal pelvis with mild to moderate hydronephrosis seen on ultrasound or uroscanner. A ureteral catheter was inserted cystoscopically, and saline was injected for more localization of the pelvicalyceal system (PCS) if needed. Puncture of the PCS was performed with an 18-gauge nephrostomy needle through the calyx, and all the stages, including dilatation, were performed under ultrasonography guidance. Results: Pyelocaliceal access: 95% of the lower caliceal group, 5% of the middle caliceal group, no case in the upper caliceal group. The intervention time was 12.4 +/- 3.7minutes. The average number of punctures was 1.25 +/- 32. There was a correlation between the number of punctures and the patient's BMI with p = 0.016. Complications: 13 cases (10%) significant bleeding have to blood transfusions, 10 cases (7.7%) postoperative fever, one case (0.8%) pseudo-aneurysm after seven days, and one case (0.8%) perirenal fluid collection. Conclusion: ultrasound guidance for renal access and tract dilation in PCNL is a useful technique and fewer complications; however, more experience is needed.