Beiko D 1 1 Department of Urology, Queen’s University, Kingston, ON, Canada , Razvi H 2 2 Division of Urology, Department of Surgery, Western University, London, ON, Canada , Bhojani N 3 3 Division of Urology, Université de Montréal, Montreal, QC, Canada , Bjazevic J 2 2 Division of Urology, Department of Surgery, Western University, London, ON, Canada , Bayne DB 4 4 Department of Urology, University of California at San Francisco, San Francisco, CA, United States , Tzou DT 5 5 Division of Urology, Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, United States , et al.
COMMENT
Ultrasound-guided percutaneous nephrolithotomy (US-PNL) has gained popularity in many parts of the world in the past few years (11. TLi J, Xiao B, Hu W, Yang B, Chen L, Hu H, et al. Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8,025 cases in China. Chin Med J (Engl). 2014;127:4184-9.). It may be used in combination with fluoroscopy to reduce ionizing radiation exposure or replacing fluoroscopy to completely eliminate exposure to radiation during PNL (22. Zhu W, Li J, Yuan J, Liu Y, Wan SP, Liu G, et al. A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy. BJU Int. 2017;119:612-8.). However, this technique can be challenging to learn.
This article provides some interesting key points for those who would like to start a US-PNL program. Despite other authors claim no different results for obese vs. non-obese patients (33. Jin W, Song Y, Fei X. Does Body Mass Index Impact the Outcomes of Ultrasound-Guided Percutaneous Nephrolithotomy? Urol Int. 2019;103:149-55.), according to the authors, the ideal candidate to start a learning curve of US-PNL is a healthy non-obese patient whose imaging demonstrates a non-staghorn calculus and at least moderate hydronephrosis. The authors described in details eight steps for a successful US-PNL.
There are many advantages of the use of ultrasound in PNL and this technique should be encouraged. However, some anatomic details of the collecting system are missed by ultrasound. Therefore, it is recommended to progressively convert fluoroscopy to ultrasound guidance step-by-step as one gains experience. More important than completely eliminate exposure to radiation is to keep patient safe from injuries due to suboptimal image guidance.
REFERENCES
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1TLi J, Xiao B, Hu W, Yang B, Chen L, Hu H, et al. Complication and safety of ultrasound guided percutaneous nephrolithotomy in 8,025 cases in China. Chin Med J (Engl). 2014;127:4184-9.
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2Zhu W, Li J, Yuan J, Liu Y, Wan SP, Liu G, et al. A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy. BJU Int. 2017;119:612-8.
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3Jin W, Song Y, Fei X. Does Body Mass Index Impact the Outcomes of Ultrasound-Guided Percutaneous Nephrolithotomy? Urol Int. 2019;103:149-55.
Publication Dates
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Publication in this collection
31 July 2020 -
Date of issue
Sep-Oct 2020
