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De Coninck V, Mortiers X, Hendrickx L, De Wachter S, Traxer O, Keller EX. Radiation exposure of patients during endourological procedures. World J Urol 2024; 42:266. [PMID: 38676726 DOI: 10.1007/s00345-024-04953-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS). METHODS Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards. RESULTS RD was generally highest for PCNL, reaching levels up to 33 mSv, 28,700 mGycm2, and 430.8 mGy. This was followed by SWL, with RD reaching up to 7.32 mSv, 13,082 mGycm2, and 142 mGy. URS demonstrated lower RD, reaching up to 6.07 mSv, 8920 mGycm2, and 46.99 mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD. CONCLUSIONS This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands.
| | - Xavier Mortiers
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Laura Hendrickx
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Stefan De Wachter
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Olivier Traxer
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Etienne X Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Meria P, Almeras C. 2022 Recommendations of the AFU Lithiasis Committee: Radiation protection in the operating theater. Prog Urol 2023; 33:883-887. [PMID: 37918988 DOI: 10.1016/j.purol.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 11/04/2023]
Abstract
It has been shown that the relative risk of cancer is higher in patients with urinary stone disease, probably due to the repeated radiological exams and procedures under fluoroscopic guidance. Reducing the radiation doses delivered to the patient also decreases the doses delivered to the operators and their assistants. The doses delivered during endoscopic procedures decrease with the urologist's experience. Training in radiation protection and the use of protocols can decrease the use of ionizing radiation in the operating room. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and whether they were adaptable to the French context.
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Affiliation(s)
- P Meria
- Service d'urologie, hôpital Saint-Louis, AP-HP-centre université Paris Cité, Paris, France
| | - C Almeras
- UroSud, clinique La Croix du Sud, Quint-Fonsegrives, France.
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Mirani KK, Ather MH, Kazmi Z, Aziz W. Access and Fluoroscopy Time Difference in Patients Undergoing Prone Percutaneous Nephrolithotomy (PCNL) With Ureteric Catheter Placement in Supine Versus Lithotomy Position. Cureus 2022; 14:e26220. [PMID: 35911369 PMCID: PMC9312847 DOI: 10.7759/cureus.26220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: To compare the operative and fluoroscopy time in two different methods of ureteral stent insertion before prone percutaneous nephrolithotomy (PCNL). Materials and method: Over 12 months, 124 patients with urolithiasis who went through prone PCNL were included in our study. All the patients had kidney stones and were divided into two groups based on the method of ureteral catheter insertion. This was done with the help of flexible or rigid cystoscopy in to group A and group B, respectively. Both groups had an equal number of patients, i.e., 62. The main outcome variables assessed were access time (from intubation to placement of access sheath) and fluoroscopy time during access. Results: The categorical variables (age, gender, site of the stone) between the two groups were comparable. The access time in groups A and B were 48±4.30 and 77±10 minutes, respectively. The fluoroscopy times in groups A and B were 52±14.63 and 116±47.77 seconds, respectively. A statistically significant difference (p-value < 0.05) was observed for both the access and fluoroscopy time. None of the patients in either of the groups had a misplaced ureteral catheter requiring repositioning. Conclusion: Flexible cystoscope-assisted insertion of ureteral catheter prior to PCNL significantly reduces operative time, fluoroscopy time, and consequently radiation exposure during PCNL.
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Ultra-mini-PCNL using the urological Dyna-CT in small infants: a single-center experience. Int Urol Nephrol 2022; 54:979-984. [DOI: 10.1007/s11255-022-03150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022]
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Bayram Ilikan G, Karabulut B, Tiryaki HT. Can ultrasound guidance reduce radiation exposure significantly in percutaneous nephrolithotomy in pediatric patients? Urolithiasis 2021; 49:173-180. [PMID: 33416916 DOI: 10.1007/s00240-020-01241-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
In this study, we aimed to compare clinical and technical outcomes between pediatric patients who underwent percutaneous nephrolithotomy (PCNL) under fluoroscopy (FL) and those that underwent this procedure under FL with ultrasound assistance (FLUSA). The data of 66 PCNL patients were analyzed retrospectively. Renal puncture was successful in 22 patients in the FLUSA group and 44 patients in the FL group. In all cases, FL was used for tract dilation and confirmation of ureteral catheter positioning at the beginning of the procedure. The sample consisted of 46 males and 20 females with a mean age of 7.2 ± 2.1 years (range 1-17 years). Stone size varied from 8.0 to 75.4 mm, and 89% of patients achieved a completely stone-free state. The median puncture time was 130.5 ± 25.3 s for FLUSA and 295 ± 82.8 s for FL, the median fluoroscopic screening time was 95 ± 33 and 230 ± 116 s, respectively, and the median radiation dose was 19.04 ± 9.9 dGy/cm2 and 54 ± 21.4 dGy/cm2, respectively. The median puncture time, fluoroscopic screening time, and radiation dose were statistically lower in the FLUSA group (p = 0.001, Mann-Whitney U test). The greatest problem in PCNL is the use of fluoroscopy. Due to some anatomical differences from adults, applying PCNL in pediatric patients using only ultrasound may decrease the success rate. Puncture with ultrasound significantly reduces the radiation dose in children. Puncture with ultrasound and dilation under fluoroscopy is a successful and safe treatment method with low morbidity and high success rates and shorter hospital stay in pediatric patients.
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Affiliation(s)
- Gulsah Bayram Ilikan
- Deparment of Radiology, Ankara City Hospital, Üniversiteler Mahallesi 1604. St. No: 9, 06800, Çankaya/Ankara, Turkey.
| | - Bilge Karabulut
- Deparment of Pediatric Urology, Ankara City Hospital, Üniversiteler Mahallesi 1604. St. No: 9, 06800, Çankaya/Ankara, Turkey
| | - H Tugrul Tiryaki
- Deparment of Pediatric Urology, Ankara City Hospital, Üniversiteler Mahallesi 1604. St. No: 9, 06800, Çankaya/Ankara, Turkey
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Vassileva J, Zagorska A, Basic D, Karagiannis A, Petkova K, Sabuncu K, Saltirov I, Sarica K, Skolarikos A, Stavridis S, Trinchieri A, Tzelves L, Ulus I, Yuruk E. Radiation exposure of patients during endourological procedures: IAEA-SEGUR study. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:1390-1405. [PMID: 33086202 DOI: 10.1088/1361-6498/abc351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
Fluoroscopy is increasingly used to guide minimally invasive endourological procedures and optimised protocols are needed to minimise radiation exposure while achieving best treatment results. This multi-center study of radiation exposure of patients was conducted by the South-Eastern European Group for Urolithiasis Research (SEGUR), in cooperation with the International Atomic Energy Agency. Seven clinical centers from the SEGUR group collected data for 325 procedures performed within a three-months period, including standard percutaneous nephrolithotomy (PCNL), mini PCNL, retrograde intrarenal surgery (RIRS), semirigid ureterorenoscopy (URS) and flexible URS. Data included: air kerma area product (PKA), air kerma at the patient entrance reference point (Ka,r), fluoroscopy time (FT), number of radiographic images (N) and fluoroscopy pulse rate, as well as total procedure duration, size and location of stones. Data were centrally analysed and statistically compared. MedianPKAvalues per center varied 2-fold for RIRS (0.80-1.79 Gy cm2), 7.1 fold for mini-PCNL (1.39-9.90 Gy cm2), 7.3 fold for PCNL (2.40-17.50 Gy cm2), 19 fold (0.13-2.51 Gy cm2) for semi-rigid URS and 29-fold for flexible URS (0.10-2.90 Gy cm2). LowerPKAandKa,rwere associated with use of lower FT,Nand lower fluoroscopy pulse rate. FT varied from 0.1 to 14 min, a small fraction of the total procedure time, ranging from 10 to 225 min. HigherNwas associated with higherPKAandKa,r. Higher medianPKAin PCNL was associated with the use of supine compared to prone position. No correlation was found between the concrement size and procedure duration, FT,PKAorKa,r. Dose values for RIRS were significantly lower compared to PCNL. The maximumKa,rvalue of 377 mGy was under the threshold for radiation induced skin erythema. The study demonstrated a potential for patient dose reduction by lowering FT andN, using pulsed fluoroscopy and beam collimation.
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Affiliation(s)
- Jenia Vassileva
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna, Austria
| | - Anna Zagorska
- Second Nuclear Medicine Department, Acibadem City Clinic UMHAT, Sofia, Bulgaria
| | | | - Andreas Karagiannis
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
- Department of Urology, Athens Euroclinic Hospital, Athens, Greece
| | - Kremena Petkova
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Karacabey State Hospital, Department of Urology, Bursa, Turkey
| | - Iliya Saltirov
- Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria
| | - Kemal Sarica
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
| | | | - Sotir Stavridis
- University Clinic of Urology, Medical Faculty Skopje, Skopje, North Macedonia
| | - Alberto Trinchieri
- Department of Urology, Manzoni Hospital, Lecco, Italy
- Department of Urology, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Lazaros Tzelves
- 2nd Department of Urology, Sismanoglio Hospital, Athens, Greece
| | - Ismail Ulus
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
| | - Emrah Yuruk
- Department of Urology, BHT ClinicIstanbul Tema Hospital, Istanbul, Turkey
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Auer A, Barabas M, Coode-Bate J, Cetti R, Walmsley B, Keoghane S. Single centre versus multi-centre pooled morbidity data in PCNL and the implications for informed consent. Scand J Urol 2020; 54:171-174. [PMID: 32223494 DOI: 10.1080/21681805.2020.1740780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: National and international outcome data following PCNL have been available for many years, but multi-centre data may not reflect the outcome from an individual surgeon or hospital.Methods: A combination of retrospective and prospective single centre data was collated from 2000-2016 and are compared to large single and multi-centre series.Results: Data were available on 801 unique cases performed between 2000 and 2016, mean age = 55.2 (SD = 14.8) (range = 17-93). The mean change in haemoglobin after PCNL was 1.65 g/dL ± 0.05, n = 630. Twenty-seven patients required a blood transfusion (3.37%). In 470 cases, data on pre-operative urine culture was available. One hundred and nineteen (25%) demonstrated evidence of bacteriuria pre-operatively. The most common isolated species were E. Coli and Proteus Mirabilis. Pre-operative urine infection was associated with a greater drop in haemoglobin following surgery, but this difference was not found to be statistically significant. Changes in serum creatinine and eGFR rise following surgery were calculated. The mean rise was found to be 15.21 µmol/L (SE = 2.08, n = 208). The mean drop in eGFR was estimated to be 7.35 ml/min/1.73 m2 (± 0.895, n = 205). Eight cases of 801 (1%) required admission to higher level care. There was one small bowel puncture and one pleural perforation recorded. Sub-selective embolization due to bleeding occurred in six cases (0 .75%) and there were no peri-operative deaths in this series. Published data comparing single centres with > 500 cases are presented.Conclusion: To facilitate transparent consent, single-centre rather than pooled outcome data should be utilized.
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Affiliation(s)
- A Auer
- Department of Urology, Portsmouth NHS Trust, Portsmouth, UK
| | - M Barabas
- Department of Urology, West Suffolk Hospital, Bury St Edmunds, UK
| | - J Coode-Bate
- Department of Urology, West Suffolk Hospital, Bury St Edmunds, UK
| | - R Cetti
- Tamar Urology, Launceston, Australia
| | - B Walmsley
- Department of Urology, Portsmouth NHS Trust, Portsmouth, UK
| | - S Keoghane
- Department of Urology, West Suffolk Hospital, Bury St Edmunds, UK
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Simson N, Stonier T, Suleyman N, Hendry J, Salib M, Peacock J, Connor M, Jones O, Schuster-Bruce J, Bottrell O, Lovegrove C, English L, Hamami H, Horn C, Bagley J, Bareh A, Jaikaransingh D, Mohamed N, Ukwu U, Shanmugathas N, Batura D, McDonald J, Charitopoulos K, Graham A, Zakikhani P, Taneja S, Sells H, Bolgeri M, Wiseman O, Bycroft J, Qteishat A, Aboumarzouk O. Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study. BJU Int 2019; 125:292-298. [PMID: 31437345 DOI: 10.1111/bju.14903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nick Simson
- Department of Urology; Guy's Hospital; London UK
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Baralo B, Samson P, Hoenig D, Smith A. Percutaneous kidney stone surgery and radiation exposure: A review. Asian J Urol 2019; 7:10-17. [PMID: 31970066 PMCID: PMC6962710 DOI: 10.1016/j.ajur.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/06/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022] Open
Abstract
During the past 3 decades, radiation exposure (RE) has increased drastically among patients undergoing percutaneous nephrolithotomy (PCNL), thus potentially causing new cases of cancer each year. The effective dose received by patients comes from pre- and post-operative computed tomography (CT) and intraoperative fluoroscopy (FL). We reviewed literature to find novel techniques and approaches that help to decrease RE of patients and personnel. We performed PubMed search using keywords percutaneous nephrolithotomy, intraoperative fluoroscopy, radiation exposure, imaging, percutaneous access, ultrasound, computed tomography, endoscopy, reconstruction, innovations, and augmented reality. Forty-four relevant articles were included in this review. As much as 20% of patients with first diagnosed urolithiasis exceed background RE level almost 17-fold. For diagnosing purposes using low-dose and ultra-low-dose CT, as well as low-dose dual energy scan protocols can be efficient ways to decrease RE while maintaining decent accuracy. Patients with urinary stones can be effectively monitored with digital tomosynthesis, ultrasound alone or ultrasound combined with plain film of the abdomen. Percutaneous access (PCA) into the kidney can be performed with reduced or even no RE, using novel PCA methods. REs from conventional imaging techniques during diagnosis and treatment increase probability of non-stochastic radiation effects. Urologists should be aware of protocols that decrease RE from CT and FL in diagnosis and management of urinary stones. Consideration of recently developed imaging modalities and PCA techniques will also aid in adherence to the “as low as reasonably achievable” principle.
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Affiliation(s)
- Bohdan Baralo
- Urology Department, National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Patrick Samson
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - David Hoenig
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
| | - Arthur Smith
- Department of Urology, Smith Institute for Urology, Northwell Health, New Hyde Park, NY, USA
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Rassweiler-Seyfried MC, Rassweiler JJ, Weiss C, Müller M, Meinzer HP, Maier-Hein L, Klein JT. iPad-assisted percutaneous nephrolithotomy (PCNL): a matched pair analysis compared to standard PCNL. World J Urol 2019; 38:447-453. [PMID: 31073641 DOI: 10.1007/s00345-019-02801-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/04/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To compare iPad-assisted (Apple Inc., Cupertino, USA) percutaneous access to the kidney to the standard puncturing technique for percutaneous nephrolithotomy (PCNL). METHODS For the iPad-assisted PCNL, a computed tomography is performed prior to surgery, using fiducial radiopaque markers. The important anatomical structures (i.e. kidney, stones) are segmented using specific software enabling the superimposition of images semi-transparently on the iPad by marker-based navigation. Twenty-two patients underwent an iPad-assisted percutaneous puncture of the kidney for PCNL. Twenty-two patients of the clinical database from the Urological Department SLK Hospital Heilbronn, who underwent the standard puncturing technique, were matched to these patients. Matching criteria were age, gender, stone volume, body mass index, stone site and the absence of anatomical variation. Puncture time, radiation exposure and number of attempts for a successful puncture were evaluated. All procedures were performed by two experienced urologists. The standard puncturing method consisted of a combination of ultrasound and fluoroscopy guidance. Chi-square and t test were used to ensure that there was no difference in the matching criteria between the groups. To compare the two methods, U test, Kruskal-Wallis and Chi-square test were used. RESULTS Examination of radiation exposure showed a significant difference between the two groups in favour of the standard puncturing method (p < 0.01) and puncture time (p = 0.01). However, there was no significant difference in puncturing attempts (p = 0.45). CONCLUSION The iPad-assisted navigation, with the objective being to puncture the renal collecting system, represents a new technique (IDEAL criteria 2b), which proved to be applicable in clinical practice, but still has potential for technical improvement.
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Affiliation(s)
- Marie-Claire Rassweiler-Seyfried
- Department of Urology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - J J Rassweiler
- Department of Urology, SLK Hospital Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - C Weiss
- Department of Medical Statistics and Biomathematics, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Müller
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - H P Meinzer
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - L Maier-Hein
- Department of Medical and Biological Informatics, German Cancer Research Centre (DKFZ), Heilbronn, Germany
| | - J T Klein
- Department of Urology, Ulm University Medical Centre, Ulm, Germany
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Sierra-Diaz E, Gaxiola-Perez E, Beas-Ruiz Velasco C, Sedano-Portillo I, Gonzalez-Gonzalez CA, Adel-Dominguez M, Davila-Radilla F. Exposure to Radioactive Emanations of Medical Personnel in Percutaneous Nephrolithotomy. Dose Response 2018; 16:1559325818777930. [PMID: 29872370 PMCID: PMC5974570 DOI: 10.1177/1559325818777930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/24/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022] Open
Abstract
The use of radioactive emanations has been of great importance for the performance of endourology procedures, such as percutaneous nephrolithotomy (NLP). The damage to health caused by radiation has been a sensitive issue. The objective of this work was to determine the dose received by the surgeon during NLP and the total dose generated by the fluoroscope. A cross-sectional study was conducted with data from a cohort study with a duration of 18 months that included 101 patients. Radiation was measured with dosimeter during the last 6 months. During the last 6 months of the study, 34 patients were submitted to surgery. The average age was 47 years. Average fluoroscopy time was 58.3 second (24-122 seconds) in both male and female groups, with 57.16 seconds and 58.95 seconds per case, respectively (P = .6). Radiation emitted during 6 months for the 34 patients was 330.5 mGy. The total radiation measured by the dosimeter was 1 mSv, which is equivalent to 0.3% of the total radiation applied during the procedures. Doses measured by the dosimeter on the surgeon were within the recommended annual doses although dose received by the hands exceeds the authorized limits (500 mSv/y).
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Affiliation(s)
- E Sierra-Diaz
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico.,Department of Surgery, University of Guadalajara, Jalisco, Mexico
| | - E Gaxiola-Perez
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - C Beas-Ruiz Velasco
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - I Sedano-Portillo
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - C A Gonzalez-Gonzalez
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - M Adel-Dominguez
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
| | - F Davila-Radilla
- Department of Urology, Western National Medical Center, Instituto Mexicano del Seguro Social (IMSS), Guadalajara, Jalisco, Mexico
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Ahlawat R. Editorial Comment. J Urol 2018; 200:201. [PMID: 29678680 DOI: 10.1016/j.juro.2018.02.3106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rajesh Ahlawat
- Fortis Escorts Kidney and Urology Institute, New Delhi, India
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Abstract
PURPOSE OF THE REVIEW To highlight the progressive evolution of the issue of patient positioning for percutaneous nephrolithotomy (PNL), explain the history of the prone and supine positions, report respective advantages and drawbacks, critically interpret the past and current literature supporting such arguments, identify the best candidates for each position, and reflect on the future evolution of the two approaches. RECENT FINDINGS Positioning for PNL has become a matter of debate during the last decade. The traditional prone PNL position - most widely performed with good success and few complications, and exhibiting essentially no limits except for the treatment of pelvic kidneys - is nowadays flanked mainly by the supine and supine-modified positions, equally effective and probably safer from an anesthesiological point of view. Of course, both approaches have a number of advantages and drawbacks, accurately reported and critically sieved. SUMMARY The current challenge for endourologists is to be able to perform PNL in both prone and supine positions to perfectly tailor the procedure on any patient with any stone burden, including increasingly challenging cases and medically high-risk patients, according to the patient's best interest. Intensive training and experience is especially needed for supine PNL, still less popular and underperformed worldwide. VIDEO ABSTRACT http://links.lww.com/COU/A8.
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