title: Pulsed versus continuous mode fluoroscopy during PCNL: safety and effectiveness comparison in a case series study.
abstract: To compare the total fluoroscopy time (FT) based on the fluoroscopy mode used-continuous vs. pulsed-in patients who underwent percutaneous nephrolithotomy (PCNL). The study cohort evaluated 111 patients who underwent PCNL by a single surgeon. Standard (continuous) fluoroscopy of 30 frames per second (fps) was used in the first 56 cases (SF group), while the next 55 consecutive cases were performed under pulsed fluoroscopy of two fps (PF group). The presence of surgeon's previous experience decreased the possible impact of the learning curve on the outcome. In both groups, using ultrasound in combination to fluoroscopy performed the renal access. The stone complexity was determined using Guy's stone score (GSS). Complications were evaluated using Clavien-Dindo classification. Median FT was significantly lower in PF group (76.8 s) compared to SF group (155.4 s) (p < 0.001). Stone-free rate was related to the Guy's stone score (GSS) classification reaching 100 % in GSS 1 cases in both groups. In GSS 2 cases the stone free rate was 87.5 % in SF group, while in PF group it was 92.3 %. Stone free rate in GSS 3 cases was 73.3 and 85.7 % in SF and PF groups, respectively. In cases of GSS 4 stone free rate was 52 % in SF group and 55.6 % in PF group, respectively. Presence of residual fragments and complications were comparable in both groups. Following ultrasound-guided puncture during PCNL, the use of pulsed fluoroscopy leads to significantly lower radiation exposure comparing to the use of continuous fluoroscopy. This advantage does not compromise the safety and efficacy of the procedure.
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia. odurutovic@gmail.com.
authors.forename: Otas
authors.initials: O
authors.lastname: Durutovic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dzamic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Bogomir
authors.initials: B
authors.lastname: Milojevic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Nikic
authors.affiliation: Clinical Center of Serbia, Center for Anesthesia and Resuscitation, School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Mimic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Uros
authors.initials: U
authors.lastname: Bumbasirevic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Vuksanovic
authors.affiliation: Clinical Center of Serbia, Clinic of Urology, School of Medicine, University of Belgrade, Resavska 51, Belgrade, 11000, Serbia.
authors.forename: Dragica Milenkovic
authors.initials: DM
authors.lastname: Petronic
authors.affiliation: 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens, Athens, Greece.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Papatsoris
authors.affiliation: 2nd Urology Department, Athens Medical School, Sismanogleio General Hospital, University of Athens, Athens, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Skolarikos
mesh_terms: D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Fluoroscopy time; Percutaneous nephrolithotomy; Pulsed fluoroscopy; Radiation exposure; Ultrasound guidance