A Comparative Study of Antegrade Air Pyelogram and Retrograde Air Pyelogram for Initial Puncture Access during Percutaneous Nephrolithotomy

Air vs contrast pyelogram for initial puncture access in percutaneous nephrolithotomy: a randomized controlled trial

Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal stones. Contrast (traditionally) as well as air is being used to delineate pelvi-calyceal system (PCS) to perform initial puncture. Contrast, when used has certain disadvantages including poor differentiation of anterior and posterior calyces. In this interim analysis of 122 patients of a prospective study subjects were stratified in two groups: in group 1, contrast was used while in group 2, air was used to delineate PCS. Out of 122,103 patients underwent puncture by contrast or air exclusively while 19 patients required mix of contrast and air (14 patients failed puncture using contrast while 5 using air). Mean dosage of radiation exposure (8.43 vs. 14.26 mGy), duration of radiation exposure (0.66 vs. 1.02 min), access time (3.72 vs. 5.84 min), were less in group 2 as compared to group 1. 84.5% of patients underwent puncture in single attempt in group 2 as compared to 56.25% in group 1. Five patients had post-operative fever and one had trans-pleural tract dilation. Complete stone clearance was seen in 94.8% of patients using air to only 75% of patients using contrast. Conclusion: Air pyelogram is a feasible, safe, cost effective and efficient access alternative to contrast pyelogram and in difficult situation a mixture of both is better than using one.

Air embolism during percutaneous nephrolithotomy using air pyelogram during initial access: Does it really occur?

INTRODUCTION

In the present era, percutaneous nephrolithotomy (PCNL) is the standard treatment for large (>2 cm) renal or staghorn renal stones. Both air and iodinated contrast has been used to opacify the pelvicalyceal system (PCS) before the dilatation of the tract. There are rare reports of air embolism following air pyelogram on mere presumptions.

MATERIALS AND METHODS

This is a prospective observational study. A total of 164 patients underwent PCNL in which air was used to opacify the PCS by placing a ureteric catheter for initial access.

RESULTS

None of our patients developed any complication during the procedure or in the postoperative period, which could be attributed to air embolism.

CONCLUSIONS

The present study ascertains that using air for opacification of PCS for initial puncture access is a safe and acceptable alternative to iodinated contrast.