Comparison of ultrasound-guided two-step tract dilation versus fluoroscopic dilation in percutaneous nephrolithotomy: safety and efficacy outcomes

Introduction: Fluoroscopy has been the most widely used guidance method for percutaneous nephrolithotomy (PCNL); however, radiation exposure is a significant concern. In recent years, ultrasound has gained popularity, offering several advantages. Methods : We retrospectively evaluated the data of patients from March 2019 to October 2023, dividing them into two groups: Group 1, two-step totally ultrasound-guided dilation, and Group 2, fluoroscopy-guided dilation. The objective was to establish the safety and effectiveness of this two-step dilation technique. Results : We included 148 patients, 83 in group 1 and 65 in group 2, with a mean BMI of 29.7kg/m ² . Mean stone burden was 4,773mm ³ , 55.4% were complex stones. 59.5% of cases without hydronephrosis in the targeted calyx. Fluoroscopy was absent in group 1 and 25.42 ± 19.6 seconds in group 2 (p<0.001). Surgical time was 120 (90-177.5) minutes, with no difference between the two groups. Complications were present in 12.8% of the cases. Group 1 patients had a lower complication rate than those in Group 2 (10.8% and 15.3%, respectively, p = 0.27). We had a global stone-free rate of 73.6%, group 1: 73.8%, and group 2: 73.5% (p=1.0). Multivariate analysis revealed that stone-free rate is associated with the stone location (p=0.005), calyx punctured (p=0.040) and number of tracts (p=0.044). Conclusions : Ultrasound-guided PCNL is a safe and effective technique, offering a similar stone-free rate compared to fluoroscopy and providing an alternative method to avoid radiation exposure during PCNL.