A randomized controlled study of non-vascular contrast-enhanced ultrasound and conventional ultrasound-assisted percutaneous nephrolithotomy in the treatment of renal calculi with no apparent hydronephrosis / 中华泌尿外科杂志

ABSTRACT

Objective:To compare the accuracy of renal calyceal fornix puncture and complication between non-vascular contrast-enhanced ultrasound (NV CEUS) and conventional ultrasound guided in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods:This randomized controlled trial was conducted in nephrolithiasis patients with slight or no hydronephrosis in our hospital from May 2018 to June 2019. The patients were randomized to receive NV CEUS or conventional ultrasound guided PCNL.Inclusion criteria age 18-70 years old and nephrolithiasis patients with slight or no hydronephrosis. Exclusion criteria pregnant women, functional solitary kidney, abnormal anatomy or high-risk of intestinal injury, acute urinary tract infection, coagulation dysfunction or taking drugs that affect blood coagulation, heart failure, severe arrhythmia or other high-risk diseases, abnormal renal function (SCR > 1.2-fold upper limit), or severe obesity (BMI>40 kg/m 2). Patients in both groups underwent anterorenal pyelography of renal fistula. Data of the study were recorded the decrease in hemoglobin, the puncture time, the success rate of one needle puncture, the time of hospital stay, the stone for free, and postoperative renal fistula anterograde pyelography to confirm whether the puncture was performed through the calyces. Results:A total of 48 patients were enrolled, 24 patients in each group, the preoperative parameters were comparable between the two groups(all P>0.05). The puncture accuracy of calyces fornix in experimental group and control group was 87.50%(21/24) and 41.67%(10/24), respectively.The hemoglobin drop was 2.0(0.0, 12.0) and 14.0(7.0, 17.0) g/L, the puncture time was 40.0(28.5, 53.0) and 70.0 (55.5, 84.5) seconds, and the success rate of one needle puncture was 95.83%(23/24) and 75%(18/24). The differences between the two groups were statistically significant (all P<0.05). No blood transfusion, interventional embolization, septic shock and other serious infection complications were found in the two groups. Conclusions:For nephrolithiasis patients with slight or no hydronephrosis, NV CEUS guided can significantly improve the accuracy of calyx vault puncture, shorten the puncture time and reduce bleeding compared with conventional ultrasound guided PCNL.