title: Percutaneous nephrolithotomy guided solely by ultrasonography: a 5-year study of >700 cases.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of percutaneous nephrolithotomy (PCNL) solely guided by ultrasonography (US).
  
  
  METHODS
  From May 2007 to July 2012, 705 24-F-tract PCNL procedures were performed (679 patients, of whom 26 had bilateral stones). Calyceal puncture and dilatation were performed under US guidance in all cases. The procedure was evaluated for access success, length of postoperative hospital stay, complications (modified Clavien system), stone clearance and the need for auxiliary treatments.
  
  
  RESULTS
  The mean (sd) operating time was 66 (25) min, with a mean (sd) postoperative hospital stay of 3.98 (1.34) days. The patients experienced a mean (sd) haemoglobin level decrease of 2.24 (2.02) g/day and the overall stone-free rate at 4 weeks after surgery was 92.6% in patients with a single calculus and 82.9% in patients with staghorn or multiple calculi. Auxiliary treatments, including shockwave lithotripsy in 52 patients, re-PCNL in 41 patients and ureteroscopy in 18 patients, were performed 1 week after the primary procedure in 111 (15.7%) cases for residual stones >4 mm in size. The sensitivities of intra-operative US-guidance and flexible nephroscopy for detecting significant residual stones and clinically insignificant residual fragments were 95.3 and 89.1%, respectively. There were 94 grade 1 (13.3%), 17 grade 2 (2.4%), and two grade 3 (0.3%) complications, but there were no grade 4 or 5 complications.
  
  
  CONCLUSIONS
  Total US-guided PCNL is safe and convenient, and may be performed without any major complications and with the advantage of preventing radiation hazards and damage to adjacent organs.
authors.affiliation: Division of Urology, Sheng Jing Hospital, China Medical University, Shenyang, China.
authors.forename: Song
authors.initials: S
authors.lastname: Yan
authors.forename: Fei
authors.initials: F
authors.lastname: Xiang
authors.forename: Song
authors.initials: S
authors.lastname: Yongsheng
mesh_terms: D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D018084:Ultrasonography, Interventional
keywords: percutaneous nephrolithotomy; renal lithiasis; stone-free rate; ultrasonography guidance