Reducing Fluoroscopy Time in Percutaneous Nephrolithotomy

Abstract

Reducing fluoroscopy time (FT) during percutaneous nephrolithotomy (PCNL) is an opportunity for stewardship of ionizing radiation in stone patients. We present our initial results of a radiation reduction protocol (RRP) used during PCNL with fluoroscopy-guided access by the urologist. Materials and Methods: Retrospective chart review of all PCNL cases performed between January and October 2017, divided in two groups: pre-RRP (group 1) and post-RRP (group 2). Fluoroscopy was performed using low-dose and pulsed mode. Measures implemented to reduce FT include (1) one-spot images, (2) reliance on tactile feedback, and (3) using shorter segments of live fluoroscopy. The primary outcome was FT. Results: Eighty-nine PCNL procedures were performed in 89 patients, 45 in group 1 and 44 in group 2. Overall median (interquartile range) age, body mass index (BMI), and stone burden (largest axial diameter) was 56 (45-66) years, 31.3 (27-37.4) kg/m2, and 27.7 (19-41) mm, respectively, and were comparable in both the groups. The median (range) FT in group 1 and group 2 was 240 (56.0-916.0) and 65.5 (13.0-561.0) seconds (p < 0.0001), respectively. There was no correlation between FT and increasing BMI and stone burden. Overall stone-free rate was 57% (58% and 57% in group 1 and group 2, respectively, p = 0.5995), with 10 patients (11%) undergoing ancillary procedures. Overall and major (Clavien 3a+) complications occurred in 10 (11%) and 5 (6%) cases, respectively, in the overall cohort. Conclusion: FT in PCNL can be significantly reduced by adapting simple techniques and being increasingly vigilant of its usage, thereby reducing radiation exposure to the surgeon and the patient.