Ultrasound-guided renal puncture followed by non-guided tract dilatation Vs standard fluoroscopy-guided percutaneous nephrolithotomy for non-opaque renal stones; a Randomized clinical trial

Abstract

Abstract Objective to evaluate the non-inferiority of ultrasound puncture followed by non-guided tract dilatation compared to the standard fluoroscopy-guided PCNL. Materials and Methods 40 patients with non-opaque kidney stones eligible for PCNL were randomly divided into two groups. The standard fluoroscopy-guided PCNL using the Amplatz dilator was performed in the XRAY group. In the SONO group, needle puncture was done ultrasound-guided followed by non-guided dilatation using Amplatz dilator based on the tract length. In cases of short-advancement, we used bi-prong forceps under direct endoscopic vision to dilate the parenchyma. The primary outcome was successful access. Results In 90% of cases in the XRAY and 95% in the SONO group access dilatation process was performed uneventfully at the first attempt (p = 0.5). In 45% of cases in the SONO group, bi-prong forceps was used as salvage for short-advancement. In one case in the XRAY group over-advancement occurred. The stone-free rate on CT-scan one month after surgery was 75% for the XRAY group and 85% for the SONO group. (p = 0.4). There were no significant differences in operation time, hospitalization duration, transfusion, or complication rates between the two groups. Conclusion Non-guided tract dilatation after the ultrasound-guided renal puncture in PCNL followed by bi-prong forceps tract dilatation as salvage in case of short-advancement, is not inferior to the standard fluoroscopy-guided PCNL for non-opaque renal stones while eliminating radiation hazard and the risk of over-advancement.