Ultrasound Versus Fluoroscopy for Image Guidance During Percutaneous Nephrolithotomy

Introduction: Fluoroscopes are commonly used in PCNL worldwide. While ultrasound is used for screening and localization of renal stones, its role in percutaneous nephrolithotomy (PCNL) is underutilized. Objective:  To compare the operative outcome, postoperative outcome and complications of ultrasound versus fluoroscopy guided PCNL. Results: The study was performed from 1st April, 2018 to 30th Sept, 2021.  A total of 305 patients were enrolled in the study, with 122 cases performed under ultrasound (UG-PCNL) and 183 under fluoroscopy guidance (FG-PCNL). In the ultrasound group, the mean age was 48.65 ± 12.11 years. 45 were females and 77 were males with a mean stone burden of 754.33 ± 241.22 mm2, with the majority of renal units demonstrating moderate to gross hydronephrosis. While in the fluoroscopy group 81 were females and 102 were males with a mean age 46.28 ± 12.65 years and mean stone size of 763.54 ± 288.97mm2. Partial staghorn stones were found in approximately 25.4% in UG-PCNL while 34.4% in FG-PCNL group. Preoperative parameters including age, sex,  stone laterality, stone location, stone size, and severity of hydronephrosis did not differ between each group.There was no significant difference in successful tract creation, stone clearance, operation time , hospital stay, complications and ancillary procedure between UG-PCNL and FG-PCNL. Compared to fluoroscopy, ultrasonography had shorter puncture time, higher success rate of first puncture, shorter tract dilatation time, lesser drop in hemoglobin and lesser blood transfusion requirement. Conclusion: Ultrasound is a safe alternative to fluoroscopy for successful percutaneous renal access and dilatation with similar stone clearance to that of fluoroscopy. The advantages of ultrasonography over fluoroscopy include shorter puncture time, higher success rate of first puncture, lower blood loss, and lower complications. It also avoids radiation exposure and use of contrast media.