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Organo Oficial de la Sociedad Mexicana de Urología

2021, Number 2

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Rev Mex Urol 2021; 81 (2)

Ultrasound-guided renal access for percutaneous nephrolithotomy at a referral center in Southeast Mexico

Magaña-González JE, Monzón-Falconi JF, Cruz-Nuricumbo E, Cruz-Ordoñez SX, Flores-Tapia JP, Esqueda-Mendoza A

Language: Spanish
References: 18
Page: 1-13
PDF size: 342.48 Kb.


ABSTRACT

Percutaneous nephrolithotomy is the treatment of choice for staghorn stones and large kidney stones (bigger than 2 cm). Percutaneous renal access can be achieved, whether guided by ultrasound or fluoroscopy. The method of choice depends on training and personal preference. Ultrasound has various strengths as an intervention tool and several advantages over fluoroscopy: it is easily available, portable, relatively inexpensive, and there is no radiation exposure. Even though the skilled use of those techniques involves a learning curve, employing them can result in lower radiation exposure to the patients, urologist, and medical assistants, when performing percutaneous nephrolithotomy.
Objectives: To describe the surgical technique and the clinical characteristics of the patients that underwent percutaneous nephrolithotomy, with ultrasound-guided renal access, at the Hospital Regional De Alta Especialidad de la Península de Yucatán, within the time frame of January 2019 and January 2021.
Materials and methods: A retrospective, descriptive, observational study was carried out utilizing the medical files of 22 patients diagnosed with kidney stones and corroborated through tomography that underwent percutaneous nephrolithotomy with ultrasound- guided puncture.
Results: Twenty-two percutaneous nephrolithotomies with ultrasound-guided renal access were performed within the time frame of January 2019 and January 2021. A total of 72.7% of the patients were women and 27.3% were men. Fifty percent of the patients were obese, 68.2% had an ASA 2 anesthetic risk, 22.7% an ASA 3, and 9.1% (2) an ASA 1. According to the Guy’s Stone Score, 40.9% of the patients had grade III stones and 27.3% had grade IV. Among the surgical characteristics: the tract was established by an endourology fellow in 45.5% of the patients, by an R5 in 22.7%, an R4 in 9.1%, and by an endourology staff physician in 22.7%. A total of 45.5% of the patients required one puncture, 5 patients required two, 5 patients required three, one patient required four, and one patient required more than five punctures. Tract creation was successful in 95.5% of the patients and failed in only one. Puncture was carried out employing the Valdivia/ Galdakao position in 90.0% (20) of the patients and the prone position in 9.1%. A single tract was established in 95.5%.
Conclusions: Ultrasound-guided access for percutaneous nephrolithotomy is a safe, effective, radiation-free, and low-cost technique that can be used at any hospital. The technique requires structured training, which should begin at the residency level.


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