Fluoroscopy-assisted ultrasound guidance for mini-percutaneous nephrolithotomy (mini-PCNL) procedures in children is a safer and more effective approach than fluoroscopy alone, researchers have found.
The results suggest that there's a way to treat children with kidney stones with lower radiation doses, wrote a team led by Amr Salama, MD, of the Alexandria School of Medicine in Egypt. The group's research was published March 13 in Urology.
"[Our study shows that] fluoroscopy-assisted ultrasonography guidance for access for PCNL seems to be an acceptable if not better option than plain fluoroscopy guidance to limit radiation exposure," the investigators noted.
The incidence of kidney stones is increasing, particularly among children, the authors explained, a trend that translates into more hospitalizations, surgeries, and healthcare costs. One of the ways the condition is treated is through percutaneous nephrolithotomy -- which is considered a first-line treatment for removing kidney stones greater than 20 mm in children; it has stone clearance success rates of 90% or higher and replaces open stone surgery. "Mini"-PCNL is a version of the procedure that further decreases bleeding, postoperative pain, and complication rates.
But PCNL does impart radiation, and clinicians have sought to mitigate this exposure, especially to pediatric patients. Using ultrasound to guide PCNL shows promise for not only identifying soft tissues and arteries and increasing accuracy of access to the stone but also conferring less radiation.
Salama and colleagues assessed whether and how much fluoroscopy-assisted, ultrasound-guided mini-PCNL could reduce radiation exposure compared to traditional fluoroscopy via a study that included 50 children who underwent the procedure between July 2022 and August 2023. Patients were divided into two groups: group A (mean age, 7 years) underwent fluoroscopy-only guided mini-PCNL, while group B (mean age, 8 years) received fluoroscopy-assisted ultrasound-guided mini-PCNL. The investigators tracked complication rate and fluoroscopy time.
The group reported the following:
| Performance of fluoroscopy alone compared with fluoroscopy with ultrasound for guiding mini-PCNL procedures | |||
|---|---|---|---|
| Measure | Fluoroscopy alone (group A) | Fluoroscopy with ultrasound guidance (group B) | p-value |
| Fluoroscopy duration (seconds) | 158 | 29 | p < 0.05 |
| Radiation dose | 32.4 mGy | 6.1 mGy | p < 0.05 |
| Time to puncture (seconds) | 136.6 | 52.2 | p < 0.05 |
| Complications rate | 16% | 12% | p = 0.65 |
| Hospital stay (days) | 2.8 | 2.2 | p = 0.16 |
The team also found an overall stone-free success rate of 96% for both patient groups.
Using ultrasound for mini-PCNL offers a promising alternative to fluoroscopy alone, according to the authors.
"The most often used access approach [for kidney stone removal] worldwide is still fluoroscopy, [but] our study findings show that [fluoroscopy and ultrasound guided] PCNL is a useful method that significantly cuts down on time and radiation exposure," they concluded.
The complete study can be found here.
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