title: A prospective and randomised trial comparing fluoroscopic, total ultrasonographic, and combined guidance for renal access in mini-percutaneous nephrolithotomy.
abstract: To compare the safety and efficacy of fluoroscopic guidance (FG), total ultrasonographic guidance (USG), and combined ultrasonographic and fluoroscopic guidance (CG) for percutaneous renal access in mini-percutaneous nephrolithotomy (mini-PCNL).
  
  
  
  The present study was conducted between July 2014 and May 2015 as a prospective randomised trial at the First Affiliated Hospital of Guangzhou Medical University. In all, 450 consecutive patients with renal stones of >2 cm were randomised to undergo FG, USG, or CG mini-PCNL (150 patients for each group). The primary endpoints were the stone-free rate (SFR) and blood loss (haemoglobin decrease during the operation and transfusion rate). Secondary endpoints included access failure rate, operating time, and complications. S.T.O.N.E. score was used to document the complexity of the renal stones. The study was registered at http://clinicaltrials.gov/ (NCT02266381).
  
  
  
  The three groups had similar baseline characteristics. With S.T.O.N.E. scores of 5-6 or 9-13, the SFRs were comparable between the three groups. For S.T.O.N.E. scores of 7-8, FG and CG achieved significantly better SFRs than USG (one-session SFR 85.1% vs 88.5% vs 66.7%, P = 0.006; overall SFR at 3 months postoperatively 89.4% vs 90.2% vs 69.8%, P = 0.002). Multiple-tracts mini-PCNL was used more frequently in the FG and CG groups than in the USG group (20.7% vs 17.1% vs 9.5%, P = 0.028). The mean total radiation exposure time was significantly greater for FG than for CG (47.5 vs 17.9 s, P < 0.001). The USG had zero radiation exposure. There was no significant difference in the haemoglobin decrease, transfusion rate, access failure rate, operating time, nephrostomy drainage time, and hospital stay among the groups. The overall operative complication rates using the Clavien-Dindo grading system were similar between the groups.
  
  
  
  Mini-PCNL under USG is as safe and effective as FG or CG in the treatment of simple kidney stones (S.T.O.N.E. scores 5-6) but with no radiation exposure. FG or CG is more effective for patients with S.T.O.N.E. scores of 7-8, where multiple percutaneous tracts may be necessary.
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Jiasheng
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Yuan
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Yongda
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Shaw P
authors.initials: SP
authors.lastname: Wan
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Guanzhao
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Wenzhong
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Wenqi
authors.initials: W
authors.lastname: Wu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Jintai
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Dongliang
authors.initials: D
authors.lastname: Zhong
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Defeng
authors.initials: D
authors.lastname: Qi
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Lei
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Zhong
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Ze
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: He
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Suilin
authors.initials: S
authors.lastname: Lu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.|Guangdong Key Laboratory of Urology, Guangzhou, Guangdong, China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Zeng
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009403:Nephrostomy, Percutaneous; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
chemical_list: D000700:Analgesics
keywords: #KidneyStones; access; guidance; percutaneous nephrolithotomy; randomised controlled trial; urolithiasis