title: Ultrasonography-guided percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Between August 2003 and December 2007, 47 patients were treated, 29 men and 18 women, with a mean age of 33.4 years (range 21-67 yrs) and a mean stone size of 31.5 mm (range 24-46 mm). All stones were located in the renal pelvis with mild to moderate hydronephrosis seen on intravenous urography. A ureteral stent was inserted cystoscopically, and saline was injected for more localization of the pelvicaliceal system (PCS), if needed. Puncture of the PCS was performed with an 18-gauge nephrostomy needle through the lower pole calyx, and all the stages, including dilatation, were performed under ultrasonography guidance.
  
  
  RESULTS
  Thirty-nine patients were stone free in the kidneys, ureters, and bladder the day after the operation. Five patients had multiple fragments that measured about 4 to 5 mm, which passed in 4 weeks (total stone-free rate: 93.61%); failure occurred in two patients, and fluoroscopy was needed; two patients who had residual fragments that measured 10 and 12 mm underwent shockwave lithotripsy; and in one patient, a fragment that measured 7 to 8 mm migrated into the ureter--it fragmented and was removed with a ureteroscope 2 days after the operation.
  
  
  CONCLUSIONS
  PCNL using sonography is a good alternative to the fluoroscopic method. It is performed without radiation exposure to the surgeon and patient; however, more experience is needed.
authors.affiliation: Endourology Division, Department of Urology, Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Hosseini
authors.forename: Abbas
authors.initials: A
authors.lastname: Hassanpour
authors.forename: Reza
authors.initials: R
authors.lastname: Farzan
authors.forename: Alireza
authors.initials: A
authors.lastname: Yousefi
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Afrasiabi