MP44-03 ULTRASOUND-ONLY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE COMPARED TO FLUOROSCOPY-DIRECTED PCNL (2022)

You have accessJournal of UrologyCME1 May 2022MP44-03 ULTRASOUND-ONLY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE COMPARED TO FLUOROSCOPY-DIRECTED PCNL Nizar Hakam, Gregory Hosier, Xavier Cortez, Fadl Hamouche, Leslie Charondo, Heiko Yang, Carter Chan, Kevin Chang, David Bayne, Marshall Stoller, and Thomas Chi Nizar HakamNizar Hakam More articles by this author , Gregory HosierGregory Hosier More articles by this author , Xavier CortezXavier Cortez More articles by this author , Fadl HamoucheFadl Hamouche More articles by this author , Leslie CharondoLeslie Charondo More articles by this author , Heiko YangHeiko Yang More articles by this author , Carter ChanCarter Chan More articles by this author , Kevin ChangKevin Chang More articles by this author , David BayneDavid Bayne More articles by this author , Marshall StollerMarshall Stoller More articles by this author , and Thomas ChiThomas Chi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002610.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Use of ultrasound guidance for percutaneous nephrolithotomy (PCNL) access has gained popularity. However, reports on ultrasound-only PCNL, in which ultrasound is used for all steps of the procedure, are limited as fluoroscopy is often used for tract dilation and to check for residual stone fragments. The study goal was to compare outcomes for ultrasound-only PCNL compared to fluoroscopy-directed PCNL. METHODS: Prospectively collected data from the Registry for Stones of the Kidney and Ureter (ReSKU) database was reviewed for all patients who underwent PCNL at one academic center from 2015-2021. Primary outcomes were complications (Clavien-Dindo classification) and stone free rates (no residual fragments ≥3 mm) compared between those who underwent ultrasound-only PCNL and fluoroscopy-directed PCNL in which any amount of fluoroscopy was used. RESULTS: 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL were identified. Mean maximum summative stone diameter was 30 mm and 44% were Guy score 3 or 4. Stone and patient characteristics were similar between both groups (Table 1). There was no difference in complication rates (15% vs. 16%, p=0.87) or stone free status (71% vs 65%, p=0.72) between those who underwent ultrasound-only PCNL and fluoroscopy-directed PCNL respectively. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 minutes vs 126 minutes, p<0.001), lower percent drop in hematocrit (2.68% vs 4.91%, p=0.02), higher success rate of access achieved by resident (38.3% vs 16.3%, p<0.001) and more frequent use of supine positioning (68.8% vs 24.5%, p <0.001) compared to fluoroscopy-directed PCNL. After adjusting for BMI, ASA, stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.706, 95% confidence interval [CI] 0.305 – 1.635, p=0.416) or residual stone fragment ≥3 mm (OR 0.989, 95% CI 0.524 – 1.866, p=0.972) compared to fluoroscopy-directed PCNL. CONCLUSIONS: Ultrasound-only PCNL is safe and achieves similar stone free rates compared to fluoroscopy-directed PCNL with added benefits of shorter operative time, less blood loss, and avoidance of radiation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e752 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nizar Hakam More articles by this author Gregory Hosier More articles by this author Xavier Cortez More articles by this author Fadl Hamouche More articles by this author Leslie Charondo More articles by this author Heiko Yang More articles by this author Carter Chan More articles by this author Kevin Chang More articles by this author David Bayne More articles by this author Marshall Stoller More articles by this author Thomas Chi More articles by this author Expand All Advertisement PDF downloadLoading ...