Vol. 6, Issue 1, Part A (2024)

In practice of Urology, percutaneous renal surgery, such as percutaneous nephrolithotomy (PCNL), is a common procedure. One of the most important steps in percutaneous renal access is the creation of a percutaneous tract into the renal collecting system. This step is usually accompanied by imaging. The benefits and drawbacks of each image guidance modality are debatable. This study compared the two commonly used imaging modalities - ultrasonography and fluoroscopy - for renal access in PCNL. This Quasi-experimental study was carried out in Department of Urology, Sir Salimullah Medical College Mitford Hospital, Dhaka, for 12-months period following the ethical approval. A total of 100 patients with renal stones of more than 2 cm in size undergoing percutaneous nephrolithotomy (PCNL) were included in this study after getting informed written consent. Study patients were divided into two groups: group-1 (n=50, PCNL under ultrasonographic guidance) and group-2 (n=50, PCNL under fluoroscopic guidance). Socio-demographic characteristics, stone related information, per- and post-operative data were collected in separate case record forms and analyzed by using SPSS 26.0. Mean age of the study patients was 41.83±9.18 years. Both groups were statistically similar regarding age, gender, BMI, size of stone, degree of hydronephrosis, and site of puncture (p>0.05). Maximum puncture was successful in first attempt in both groups (78% in group-1 and 86% in group-2, p>0.05). Ultrasonographic guided PCNL had significantly lower mean of time required for successful puncture (5.56±1.83 vs 7.40±1.14 minutes, p<0.001) and duration of radiation exposure (4.64±0.15 vs 6.93±0.43 minutes, p<0.0001) than fluoroscopic guidance. Ultrasonography guided puncture is superior to Fluoroscopic guided puncture for renal access in PCNL. However, further larger study is recommended.