Totally Ultrasound Versus Fluoroscopically Guided Complete Supine Percutaneous Nephrolithotripsy: A First Report

Purpose: As endourologists are highly exposed to X-ray irradiation during endourologic surgeries, the use of alternative methods for entrance into the collective system and dilatation of tract could be safe and less expensive. Materials and Methods: Percutaneous access was created under ultrasonographic guidance in the complete supine position without flank elevation in 14 patients (group A) and under fluoroscopic guidance in the complete supine position without flank elevation in 14 patients (group B). We performed all steps of the complete supine percutaneous nephrolithotripsy (PCNL) with ultrasonographic guidance in group A. Results: In group A, mean age of patients was 46.5 +/- 15.54 years and in group B 45.21 +/- 10.72 years. The mean stone burden was 51.07 and 41.92mm in groups A and B, respectively (p=0.54). Mean operative time in group A was 88.93 +/- 33.29 minutes and in group B it was 79.29 +/- 16.74 minutes (p=0.34). Stone-free rate was 78.6% in group A and 71.4% in group B (p=0.66). Hospital stay was 85.88 +/- 17.25 and 80.20 +/- 17.71 hours in groups A and B, respectively (p=0.12). Transfusion was done in 1 (7.14%) patient in group A and in 3 (21.43%) patients in group B (p=0.28). Fever was detected in 2 (14.28%) patients in group A and in 1 (7.14%) patient in group B (p=0.54). In our study, there were no pleural effusion, postoperative hematoma, renal pelvis perforation, and visceral organ trauma in any groups. Conclusion: We showed that totally ultrasound-guided complete supine PCNL is safe and feasible even in reoperative patients. It has certain advantages such as elimination of X-ray exposure to the surgeon and staff of the operating room, avoidance of contrast material administration, identification of all the tissue between the skin and kidney, and the energy expenditure of the surgeon and other staff of the operating room is decreased as it is not necessary to wear a lead shield.