1583 REDUCED RADIATION EXPOSURE WITH THE USE OF AN AIR RETROGRADE PYELOGRAM DURING FLUOROSCOPIC ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY (2010)

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal II1 Apr 20101583 REDUCED RADIATION EXPOSURE WITH THE USE OF AN AIR RETROGRADE PYELOGRAM DURING FLUOROSCOPIC ACCESS FOR PERCUTANEOUS NEPHROLITHOTOMY Michael Lipkin, John Mancini, Dorit Zilberman, Eliza Raymundo, Daniel Yong, Michael Ferrandino, and Glenn Preminger Michael LipkinMichael Lipkin More articles by this author , John ManciniJohn Mancini More articles by this author , Dorit ZilbermanDorit Zilberman More articles by this author , Eliza RaymundoEliza Raymundo More articles by this author , Daniel YongDaniel Yong More articles by this author , Michael FerrandinoMichael Ferrandino More articles by this author , and Glenn PremingerGlenn Preminger More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1349AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Fluoroscopy is commonly used to obtain access for percutaneous nephrolithotomy (PNL). Patient and stone related factors have been shown to effect radiation exposure during PNL. Iodinated contrast is often used to opacify the collecting system to enable access during PNL. We currently use air instead of contrast, as air has the advantages of filling the posterior calyces when the patient is in the prone position, allowing for clear visualization of the stone, without the risk of obscuring extravasation. We compared the use of air and contrast during fluoroscopic access for PNL to determine if the use of air was associated with decreased radiation exposure. METHODS We retrospectively reviewed all PNL procedures performed at our institution by a single surgeon from November 2007 to November 2009. A total of 210 PNL procedures were performed, of these 100 were performed with air pyelograms (AP). There were 84 PNL procedures with information on radiation dosage included for analysis. The effective radiation dose (ERD) was calculated using accepted conversion tables. Multivariable linear regression was used to determine the association between ERD and the use of air pyelogram controlling for factors known to increase radiation exposure (BMI, stone size, stone configuration, and number of percutaneous access tracts). RESULTS Of the 84 PNL procedures included in the study, 48 (57%) were performed with an air pyelogram and 36 (43%) used iodinated contrast (IC). The mean ages were 50.4 and 52.8 years in the AP nd IC groups, respectively. The AP group had a median BMI of 29.4 kg/m2 compared to 30.6 kg/m2 in the IC group. Median stone sizes were 4.0 cm2 and 3.6 cm2 for the AP and IC groups respectively. The mean number of accesses for the AP and IC groups were 1.29 and 1.03 respectively. After controlling for BMI, stone burden/configuration, and number of percutaneous tracts, multivariate linear regression showed significantly lower radiation exposure in the air pyelogram group compared to the contrast pyelogram group (p=0.001). Using an AP lowered the mean adjusted effective radiation dose nearly two fold, from 8.16 (CI=6.21-10.71) to 4.43 (CI=3.50-5.60) mSv. CONCLUSIONS Air retrograde pyelogram is associated with decreased radiation exposure during PNL when compared to contrast retrograde pyelogram. Factors that may lead to reduced radiation exposure include better visualization of the stone with air, lack of extravasation, and preferential filling of posterior calyces in the prone position. These advantages facilitate fluoroscopic access during PNL. Durham, NC© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e611-e612 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Lipkin More articles by this author John Mancini More articles by this author Dorit Zilberman More articles by this author Eliza Raymundo More articles by this author Daniel Yong More articles by this author Michael Ferrandino More articles by this author Glenn Preminger More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...