Abstract :
Background Although percutaneous nephrolithotomy is most commonly
performed with fluoroscopic access, yet, phobia and risks of radiation
exposure are 2 important dilemmas. Herein the feasibility of flank
position ultrasound guided percutaneous nephrolithotomy for management
of renal stones was assessed. Methods Between September 2012 and June
2016, 250 cases (134 males and 116 females) with renal stone underwent
ultrasonography-guided percutaneous nephrolithotomy under lateral
decubitus position. The exclusion criteria were active urinary tract
infection and bleeding status. The peri-operative surgical outcomes were
recorded and analyzed. Results The mean age of patients was 42.0 ± 13.4
years. Twelve patients were children under 12 years old. Mean size of
the stones was 4.2 ± 1.1 cm (range from 2.5 to 5.3 cm). Mean access and
operative times were 15.5 ± 2.3 and 68 ± 14.5 minutes, respectively. In
45% of patients, superior calyx was selected for access. History of
previous open stone surgery was obtained in 24 cases. Early complete
stone free rate (SFR) was 68%, and after auxiliary procedures (SWL and
TUL), this increased to 88%. The mean hemoglobin reduction was 1.9 ± 0.9
gr/dL. Blood transfusion was needed in 6 cases (2.4%). Prolonged or
delay hemorrhage did not occur in any of the patients. One patient was
complicated by moderate degree of pneumothorax and managed with chest
tube insertion. Solid or viscus abdominal organ injury had not happened.
Conclusions This study suggested that the feasibility and outcomes of
ultrasonography-guided percutaneous nephrolithotomy are comparable with
the standard fluoroscopic approach. Also flank position can facile this
procedure.
