title: Percutaneous nephrolithotomy with and without retrograde pyelography: preliminary results of a randomized controlled trial.
abstract: BACKGROUND
  Since the introduction of percutaneous nephrolithotomy (PNL), many modifications to entering the pyelocalyceal system have been made. One alternative is to insert a needle pointed to an opaque stone as a landmark. The aim of this study was to compare the outcomes of managing kidney calculi by PNL with and without retrograde pyelography.
  
  
  METHODS
  In this randomized controlled trial, 55 candidates for PNL with a single opaque kidney calculus in the calyx alone, the pelvis alone, or both the calyx and the pelvis were assigned into 2 groups. Twenty-seven patients underwent PNL with a ureteral catheter, and 28 patients underwent PNL without a ureteral catheter. Clinical outcomes were compared between the 2 groups using plain radiographs taken on the first day after the procedure.
  
  
  RESULTS
  Patients had similar distributions regarding sex, age, operative time, hospital stay, past surgical history on the kidneys, and stone size. There was a significantly greater decrease in postoperative hemoglobin level in patients having PNL with a ureteral catheter (P < 0.001) than in those having the procedure without a ureteral catheter. No differences were seen among patients in the 2 groups in terms of stone-free rate, and number of patients with insignificant residue, and those needing extracorporeal shock wave lithotripsy, a second PNL procedure, or transurethral lithotripsy.
  
  
  CONCLUSIONS
  Percutaneous nephrolithotomy without ureteral catheterization has specific benefits: urine leakage is lower and there is no need to perform cystoscopy. Patients with a single kidney calculus are good candidates for PNL without previous ureteral catheter insertion.
authors.affiliation: Department of Urology, Shaheed Labbafinejad Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: Hamed
authors.initials: H
authors.lastname: Akhavizadegan
authors.forename: Kia
authors.initials: K
authors.lastname: Nouri Mahdavi
authors.forename: Mohammad
authors.initials: M
authors.lastname: Najafi Semnani
authors.forename: Mojgan
authors.initials: M
authors.lastname: Karbakhsh Davari
authors.forename: Ali Reza
authors.initials: AR
authors.lastname: Niroomand