title: Blind versus fluoroscopy-guided percutaneous nephrolithotomy: a randomized clinical trial.
abstract: OBJECTIVE
  Due to the negative impact of radiation on the patient and the surgical team during percutaneous nephrolithotomy (PCNL), we aimed to evaluate success rate and complications of blind access for PCNL using lumbar notch landmark and compare with conventional fluoroscopy-guided access.
  
  
  METHODS
  In a clinical trial, 100 patients who were candidate for PCNL, were randomly assigned into blind group (1) and fluoroscopy-guided group (2). In group 1 the lumbar notch was used to guide percutaneous access and in group 2 fluoroscopy performed after needle insertion, Amplatz placement and at the end of surgery. If the access failed, we would repeat puncturing up to 5 times. In group 2, access was achieved using full fluoroscopy guidance. All patients underwent postoperative assessment including kidney-ureter-bladder X-ray and ultrasonography.
  
  
  RESULTS
  Both mean access time and mean operation time were statically similar in group 1 and group 2 (3.3 ± 0.5 vs. 3.6 ± 0.7 min and 35.2 ± 4.6 vs. 38.9 ± 4.1 min, respectively). A successful puncture was achieved in 86% and 94% of the patients in groups 1 and 2, respectively (P = .18). Total success rate of procedure was 80% and 88% of the patients in groups 1 and 2, respectively (P = .27).
  
  
  CONCLUSIONS
  According to this study, it seems that blind access is a safe and effective PCNL method, and we recommend employment of this technique by skilled endourologist in urology centers especially for patient with large hydronephrotic kidney.
authors.affiliation: Urology and Nephrology Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. karami_hosein@yahoo.com.
authors.forename: Hossein
authors.initials: H
authors.lastname: Karami
authors.affiliation: Department of Urology, Medical Laser Application Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. mazloomfard@yahoo.com.
authors.forename: Mohammad Mohsen
authors.initials: MM
authors.lastname: Mazloomfard
authors.affiliation: Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Aida
authors.initials: A
authors.lastname: Moeini
authors.affiliation: Urology and Nephrology Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. drmohammadhosseini@yahoo.com.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mohammadhosseini
authors.affiliation: Urology and Nephrology Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences,Tehran,Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Rezaei
authors.affiliation: Department of Urology, Medical Laser Application Research Center, Shohadae Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Behzad
authors.initials: B
authors.lastname: Lotfi
mesh_terms: D000328:Adult; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016037:Single-Blind Method