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Davis NF, Tzelves L, Geraghty R, Lombardo R, Yuan C, Petrik A, Neisius A, Gambaro G, Jung H, Shepherd R, Tailly T, Somani B, Skolarikos A. Comparison of Treatment Outcomes for Fluoroscopic and Fluoroscopy-free Endourological Procedures: A Systematic Review on Behalf of the European Association of Urology Urolithiasis Guidelines Panel. Eur Urol Focus 2023; 9:938-953. [PMID: 37277273 DOI: 10.1016/j.euf.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/25/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
CONTEXT Endourological procedures frequently require fluoroscopic guidance, which results in harmful radiation exposure to patients and staff. One clinician-controlled method for decreasing exposure to ionising radiation in patients with urolithiasis is to avoid the use of intraoperative fluoroscopy during stone intervention procedures. OBJECTIVE To comparatively assess the benefits and risks of "fluoroscopy-free" and fluoroscopic endourological interventions in patients with urolithiasis. EVIDENCE ACQUISITION A systematic review of the literature from 1970 to 2022 was performed using the MEDLINE/PubMed, Embase, and Cochrane controlled trials databases and ClinicalTrials.gov. Primary outcomes assessed were complications and the stone-free rate (SFR). Studies reporting data on ureteroscopy and percutaneous nephrolithotomy (PCNL) were eligible for inclusion. Secondary outcomes were operative duration, hospital length of stay, conversion from a fluoroscopy-free to a fluoroscopic procedure, and requirement for an auxiliary procedure to achieve stone clearance. EVIDENCE SYNTHESIS In total, 24 studies (12 randomised and 12 observational) out of 834 abstracts screened were eligible for analysis. There were 4564 patients with urolithiasis in total, of whom 2309 underwent a fluoroscopy-free procedure and 2255 underwent a comparative fluoroscopic procedure for treatment of urolithiasis. Pooled analysis of all procedures revealed no significant difference between the groups in SFR (p = 0.84), operative duration (p = 0.11), or length of stay (p = 0.13). Complication rates were significantly higher in the fluoroscopy group (p = 0.009). The incidence of conversion from a fluoroscopy-free to a fluoroscopic procedure was 2.84%. Similar results were noted in subanalyses for ureteroscopy (n = 2647) and PCNL (n = 1917). When only randomised studies were analysed (n = 12), the overall complication rate was significantly in the fluoroscopy group (p < 0.001). CONCLUSIONS For carefully selected patients with urolithiasis, fluoroscopy-free and fluoroscopic endourological procedures have comparable stone-free and complication rates when performed by experienced urologists. In addition, the conversion rate from a fluoroscopy-free to a fluoroscopic endourological procedure is low at 2.84%. These findings are important for clinicians and patients, as the detrimental health effects of ionising radiation are negated with fluoroscopy-free procedures. PATIENT SUMMARY We compared treatments for kidney stones with and without the use of radiation. We found that kidney stone procedures without the use of radiation can be safely performed by experienced urologists in patients with normal kidney anatomy. These findings are important, as they indicate that the harmful effects of radiation can be avoided during kidney stone surgery.
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Affiliation(s)
- Niall F Davis
- Department of Urology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lazaros Tzelves
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Urology/Uro-oncology, University College of London Hospitals NHS Trust, London, UK
| | - Robert Geraghty
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Riccardo Lombardo
- Department of Urology ,Sant' Andrea Hospital, Sapienza University, Rome, Italy
| | - Cathy Yuan
- Division of Gastroenterology, McMaster University and Cochrane UGPD Group, Hamilton, Canada
| | - Ales Petrik
- First Faculty of Medicine, Charles University, Prague, Czechia
| | - Andrea Neisius
- Department of Urology, Bruederkrankenhaus Trier, Johannes Gutenberg University, Mainz, Germany
| | - Giovanni Gambaro
- Department of Medicine, Nephrology and Dialysis Unit, University of Verona, Verona, Italy
| | - Helene Jung
- Department of Urology, Lillebaelt and Vejle Hospitals, University of Southern Denmark Odense, Denmark
| | - Robert Shepherd
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Thomas Tailly
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andreas Skolarikos
- Department of Urology, Sismanogleio Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Arabzadeh Bahri R, Maleki S, Shafiee A, Shobeiri P. Ultrasound versus fluoroscopy as imaging guidance for percutaneous nephrolithotomy: A systematic review and meta-analysis. PLoS One 2023; 18:e0276708. [PMID: 36862676 PMCID: PMC9980746 DOI: 10.1371/journal.pone.0276708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES To determine whether the outcomes of ultrasound-guided percutaneous nephrolithotomy (UG-PCNL), an alternative to traditional fluoroscopy-guided percutaneous nephrolithotomy (FG-PCNL), are comparable. METHODS A systematic search of PubMed, Embase, and the Cochrane Library was carried out to discover investigations comparing UG-PCNL to FG-PCNL, and accordingly, a meta-analysis of those studies was performed. The primary outcomes included the stone-free rate (SFR), overall complications based on Clavien-Dindo classification, duration of surgery, duration of patients' hospitalization, and hemoglobin (Hb) drop during the surgery. All statistical analyses and visualizations were implemented utilizing R software. RESULTS Nineteen studies, including eight randomized clinical trials (RCTs) and eleven observational cohorts, comprising 3016 patients (1521 UG-PCNL patients) and comparing UG-PCNL with FG-PCNL met the inclusion criteria of the current study. Considering SFR, overall complications, duration of surgery, duration of hospitalization, and Hb drop, our meta-analysis revealed no statistically significant difference between UG-PCNL and FG-PCNL patients, with p-values of 0.29, 0.47, 0.98, 0.28, and 0.42, respectively. Significant differences were discovered between UG-PCNL and FG-PCNL patients in terms of the length of time they were exposed to radiation (p-value< 0.0001). Moreover, FG-PCNL had shorter access time than UG-PCNL (p-value = 0.04). CONCLUSION UG-PCNL provides the advantage of requiring less radiation exposure while being just as efficient as FG-PCNL; thus, this study suggests prioritizing the use of UG-PCNL.
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Affiliation(s)
- Razman Arabzadeh Bahri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Saba Maleki
- School of Medicine, Guilan University of Medical Sciences (GUMS), Rasht, Guilan Province, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Birowo P, Rustandi R, Risky Raharja PA, Putra HW, Rasyid N, Atmoko W. The learning curve for a single surgeon using ultrasonography to guide supine percutaneous nephrolithotomy with an alken metal telescopic dilator. Heliyon 2022; 8:e12524. [PMID: 36590495 PMCID: PMC9801132 DOI: 10.1016/j.heliyon.2022.e12524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 10/04/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Ultrasound (US) has three advantages over fluoroscopy for guiding percutaneous nephrolithotomy (PNCL): it provides an assessment of adjacent structures and real-time puncture adjustment, and is radiation free. This study aimed to define the number of procedures that should be performed to achieve competence in US-guided PCNL using an Alken metal telescopic dilator. A non-randomised retrospective study with consecutive sampling was used for the study design. A total of 50 patients above 18 years of age with the largest diameter of renal stone ≥20 mm were included. They were divided into five groups based on timing of the surgery to evaluate and visualise improvements based on primary outcomes within the groups. Line charts were used, and statistical analysis was performed to evaluate the learning curve. Most of the base characteristics between the groups were similar. Tract dilatation time decreased significantly after 20 PCNLs were performed (p < 0.001). Stone-free status markedly increased after 20 PCNLs were performed (p < 0.001). Postoperative fever (10%) and need for blood transfusion (26%) were the only complications. Basic competency was achievable after 20 PCNL procedures were performed, and further improvements in outcomes were achieved after 40 PCNLs with an acceptable rate of non-severe complications.
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Sahan A, Cubuk A, Ozkaptan O, Ertas K, Toprak T, Eryildirim B, Sarica K. How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial. Actas Urol Esp 2021; 45:486-492. [PMID: 34330691 DOI: 10.1016/j.acuroe.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). CONCLUSION US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.
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Affiliation(s)
- A Sahan
- Department of Urology, Kartal Dr. Lutfi Kirdar Traning and Research Hospital, Estambul, Turkey
| | - A Cubuk
- Department of Urology, Kırklareli University, Faculty of Medicine, Krıklareli, Turkey.
| | - O Ozkaptan
- Department of Urology, Kartal Dr. Lutfi Kirdar Traning and Research Hospital, Estambul, Turkey
| | - K Ertas
- Department of Urology, Van Yüzüncü Yıl University, Faculty of Medicine, Van, Turkey
| | - T Toprak
- Department of Urology, Fatih Sultan Mehmet Traning and Research Hospital, Estambul, Turkey
| | - B Eryildirim
- Department of Urology, Kartal Dr. Lutfi Kirdar Traning and Research Hospital, Estambul, Turkey
| | - K Sarica
- Department of Urology, Biruni University Faculty of Medicine, Estambul, Turkey
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Sahan A, Cubuk A, Ozkaptan O, Ertas K, Toprak T, Eryildirim B, Sarica K. How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial. Actas Urol Esp 2021. [PMID: 33958219 DOI: 10.1016/j.acuro.2020.10.011] [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] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (P>.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7g/dL) when compared with US-assisted group (1.3g/dL) (P<.01). The mean duration of radiation exposure was significantly higher for the FG (P<.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (P>.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (P>.05). CONCLUSION US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.
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Corrales M, Doizi S, Barghouthy Y, Kamkoum H, Somani B, Traxer O. Ultrasound or Fluoroscopy for Percutaneous Nephrolithotomy Access, Is There Really a Difference? A Review of Literature. J Endourol 2020; 35:241-248. [PMID: 32762266 DOI: 10.1089/end.2020.0672] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective: To compare whether the outcomes of ultrasound-guided access percutaneous nephrolithotomy (USGA-PCNL) are similar to standard fluoroscopy-guided access percutaneous nephrolithotomy (FGA-PCNL). Methods: A review was developed by using the MEDLINE and Scopus databases and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. Studies comparing the USGA-PCNL and the FGA-PCNL were included. Case reports, editorials and letters, unpublished studies, posters, and comments abstracts were excluded. Results: We found 12 published articles that compared USGA-PCNL and FGA-PCNL. These included six randomized controlled trials, three case-control trials, and three meta-analyses. The overall results showed no difference in the success of percutaneous access, bleeding, blood transfusion, operative time, postoperative complications, or hospital stay. Conclusion: The reported data demonstrate that there are no significant differences between the fluoroscopic-guided access PCNL and the ultrasonographic access PCNL. The choice of puncture depends on the surgeon's expertise in a particular technique and the patient and stone characteristics. Both approaches are equally safe and effective in experienced hands. It is important to recall that the use of one technique does not exclude the use of the other, and they can sometimes be complementary to each other.
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Affiliation(s)
- Mariela Corrales
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Steeve Doizi
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Yazeed Barghouthy
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Hatem Kamkoum
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, United Kingdom
| | - Olivier Traxer
- Sorbonne Université, GRC n°20, Groupe de Recherche Clinique sur la Lithiase Urinaire, Hôpital Tenon, Paris, France
- Sorbonne Université, Service d'Urologie, AP-HP, Hôpital Tenon, Paris, France
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Birowo P, Raharja PAR, Putra HWK, Rustandi R, Atmoko W, Rasyid N. X-ray-free ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a comparative study with historical control. Int Urol Nephrol 2020; 52:2253-2259. [PMID: 32710296 PMCID: PMC7655569 DOI: 10.1007/s11255-020-02577-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/14/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare the outcomes and complications of supine X-ray-free ultrasound-guided percutaneous nephrolithotomy (XG-PCNL) with fluoroscopy-guided (FG)-PCNL in both prone and supine positions. METHODS This was a comparative study that included a prospective cohort and historical control groups. This study analysed 40 consecutive patients who undergone supine XG-PCNL between October 2019 and March 2020. The control groups were composed of historical control formed from the last 40 consecutive patients who underwent FG-PCNL in both supine and prone positions from our PCNL database from January 2018 and September 2019. Patients' demographics, stone characteristics and intraoperative and postoperative outcomes were compared. RESULTS A total of 120 patients were classified into the supine XG-PCNL, supine FG-PCNL, and prone FG-PCNL groups (each N = 40). They had similar baseline characteristics and initial stone burden. The supine XG-PCNL group had higher puncture attempts, nephrostomy tube placement, and longer surgery duration than both the supine and prone FG-PCNL groups. However, the stone-free rate was similar in all groups (85%, supine XG-PCNL; 72.5%, supine FG-PCNL; 77.5% prone FG-PCNL; p = 0.39). No significant difference was found in the complication rate and length of stay among the three groups. CONCLUSION Supine XG-PCNL is an alternative to both supine and prone FG-PCNL with similar efficacy and complication rates for kidney stone patients. This could be a good alternative to urological centres with no access to fluoroscopy.
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Affiliation(s)
- Ponco Birowo
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia.
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia
| | - Harun Wijanarko Kusuma Putra
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia
| | - Reginald Rustandi
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, 10430, Indonesia
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Birowo P, Raharja PAR, Putra HWK, Rustandi R, Atmoko W, Rasyid N. X-ray-free Ultrasound-guided Percutaneous Nephrolithotomy in Supine Position Using Alken Metal Telescoping Dilators in a Large Kidney Stone: A Case Report. Res Rep Urol 2020; 12:287-293. [PMID: 32802805 PMCID: PMC7399460 DOI: 10.2147/rru.s259941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
X-ray-free ultrasound-guided percutaneous nephrolithotomy (PCNL) has been proven to be safe, feasible, and affordable. Kidney dilatation during X-ray-free ultrasound-guided PCNL is mostly using balloon dilators. This report presents our experience of performing X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescopic dilators in a patient with a large kidney stone. A 50-year-old male presented with right complete staghorn stone sized 46×30×24 mm (stone burden: 50,985 mm3 with sphere formula) and grade II hydronephrosis. The computed tomography (CT) scan showed no right ureteric stone, kinking, or stenosis. Ureteral catheter and guidewire were placed retrogradely under ultrasound guidance during cystoscopy. Normal saline was pumped via the ureteral catheter to make artificial hydronephrosis thus assisting the process. Kidney dilatation was performed with Alken metal telescoping dilators. Urine flow from the dilators confirmed that our dilator had reached the collecting system. The stone was identified and fragmented with combination of both pneumatic and shock pulse lithotripter. Double J stent and nephrostomy tubes were inserted at the end of the procedure. All of the steps were performed purely under ultrasound guidance. There was no residual stone after the procedure, confirmed by ultrasound, nephroscope, and postoperative X-ray. There was no significant complication during or after the procedure. The patient was discharged on postoperative day two. X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescoping dilators seems to be a feasible, safe, and cost-effective approach in managing kidney stones, including staghorn and large stones.
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Affiliation(s)
- Ponco Birowo
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
| | - Harun Wijanarko Kusuma Putra
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
| | - Reginald Rustandi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta10430, Indonesia
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Yang YH, Wen YC, Chen KC, Chen C. Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis. World J Urol 2018; 37:777-788. [PMID: 30244337 DOI: 10.1007/s00345-018-2443-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/09/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of ultrasound-guided (UG) versus fluoroscopy-guided (FG) percutaneous nephrolithotomy (PCNL). METHODS A systematic search of PubMed (MEDLINE), Embase, and the Cochrane Library was conducted to identify randomized controlled trials that compared UG-PCNL with FG-PCNL, and a meta-analysis of those studies was completed. The primary outcomes assessed were stone-free rate (SFR) and complication rate. Secondary outcomes assessed were the successful access-creation rate, time necessary for entrance into the target calyx, auxiliary procedure rate, transfusion rate, hemoglobin decrease after surgery, surgery duration, and hospital stay. RESULTS Eight studies comprising 966 patients were included in the meta-analysis. Compared with FG-PCNL, UG-PCNL had comparable stone-free rates [odds ratio (OR) 0.95; 95% confidence interval (CI) 0.67-1.35; p = 0.79] irrespective of the patient's position, and a favorable safety profile resulting in a lower complication rate (OR 0.56; 95% CI 0.36-0.86; p = 0.009). No statistical difference was found between UG and FG groups in secondary outcomes. CONCLUSIONS UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates. In addition, UG-PCNL could be performed with patients in the supine position without compromising its efficacy.
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Affiliation(s)
- Yu-Hsiang Yang
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Medical education, Linkou Chang Gung Memorial Hospital, Taoyuan District, Taoyuan, Taiwan
| | - Yu-Ching Wen
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Urology, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, 250 Wuxing St., Taipei, 11031, Taiwan, ROC. .,Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. .,Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan. .,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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