Ultrasonographic percutaneous nephrolithotomy, with or without ureteral catheter

Abstract

Introduction: Access by ultrasonography rather than fluoroscopy in addition to reducing radiation exposure to the patient and staff, is safe and effective. Access by ultrasonography is bi-planar and real-time compared to fluoroscopy, because it provides fewer side effects and more stone free rate. Objectives: To study the complications and outcome of PCNL (percutaneous nephrolithotomy) with or without using ureteral catheter. Patients and Methods: We studied 59 patients with at least 2 cm diameter of renal stone from January to December of 2018. After general anesthesia, 35 patients in the ureteral stent group were prepared in bladder lithotomy position. Then 5-French (Fr) ureteral catheters were introduced endoscopically in stone affected side and fixed to 16 Fr urethral Foley catheters in the patients. Other 24 patients in the non-stent group following anesthesia were directed to prone position instantly. In all of the patients, ultrasonography was performed in posterior auxiliary line below the ribs in prone position. Retrograde instillation of normal saline was performed through ureteral catheter in stent-group. Then we inserted 18G Chiba needle to desired calyx without needle holder guidance in all patients. Our approach according to probe was transverse. Results: Our patients comprised of 24 men and 35 women aged 24 to 66 years. Thirteen of them had no hydronephrosis and their stone sizes ranged from 21 mm to 65 mm. Patients in the ureteral stent group were more obese compared to the non-stent group (P=0.02) in addition to significantly more operation time (P=0.03). However hydronephrosis was not significantly different between groups (P=0.3). Postoperative residual stone rate, hospital stay days and complications (Fever, blood transfusion) were the same between both groups. Only urinary leak was more common in the non-stent group (P=0.04) Conclusion: Ultra-sonographic-PCNL without inserting ureteral catheter before surgery is conceivable especially in patients with lower body mass index (BMI). Advantages and complications are same in ureteral stent and non-stent patients except urinary leak that is more common in non-stent patients.