PCNL Safe, Effective Using Ultrasound Guidance Alone

Performing percutaneous nephrolithotomy (PCNL) under ultrasound (US) guidance alone is safe and convenient, according to investigators in China.

A team at Sheng Jing Hospital, China Medical University, Shenyang, China, led by Fei Xiang, MD, PhD, studied 679 patients who underwent PCNL under US guidance alone. Of these patients, 26 had bilateral stones. The overall stone-free rate at four weeks after surgery was 92.6% in patients with a single stone and 82.9% in patients with staghorn or multiple stones, the researchers reported in BJU International (2013;112:965-971).

Auxilliary treatments were performed one week after the primary procedure in 111 cases (15.7%) for residual stones larger than 4 mm. These treatments included shockwave lithotripsy in 52 patients, re-PCNL in 41, and ureteroscopy in 18.

A total of 94 grade 1 (13.3%), 17 grade 2 (2.4%), and two grade 3 (0.3%) complications, but no grade 4 or 5 complications, occurred.

The mean operating time was 66 minutes and the mean postoperative hospital stay was about four days. The researchers pointed out some drawbacks to the technique, noting, for example, that US guidance was not particularly efficient in extremely obese patients.

The use of US can avoid radiation exposure “and provides a reliable method for the localization of renal stones, especially non-opaque stones that are not visible via fluoroscopy,” they stated. It also can prevent damage to adjacent organs.

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