¿Cómo afecta la técnica de punción al riesgo de sangrado intraoperatorio durante la nefrolitotomía percutánea? Ensayo aleatorizado prospectivo / How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial

Introducción y objetivos: Evaluar los posibles efectos de dos técnicas diferentes de punción renal (guiada por ecografía [GE] o guiada por fluoroscopia [GF]) sobre el riesgo de hemorragia intraoperatoria durante la nefrolitotomía percutánea (NLPC).Material y métodosUn total de 130 pacientes con puntuaciones de la escala de Guy de 1-2 fueron asignados prospectivamente a los grupos de punción GE y punción GF mediante aleatorización simple. Se excluyeron del estudio los pacientes que sufrieron rotura pielocalicial durante la cirugía y los que necesitaron múltiples accesos. Aparte de los pasos relacionados con la punción, todos los demás pasos del procedimiento de NLPC fueron realizados con técnicas similares por un único cirujano. Se compararon las características de los pacientes, los datos quirúrgicos y los resultados postoperatorios.ResultadosUn total de 10 pacientes fueron excluidos del estudio debido a una complicación intraoperatoria tras la punción. Los datos demográficos de los pacientes y las características de los cálculos fueron similares entre los dos grupos (p>0,05). La media del descenso de hemoglobina fue significativamente mayor en el grupo GF (1,7g/dl) en comparación con el grupo GE (1,3g/dl) (p<0,01). La duración media de la exposición a la radiación fue significativamente mayor en el grupo GF (p<0,001). El tiempo quirúrgico total, el número de intentos para una punción exitosa, la duración de la estancia hospitalaria y la tasa libre de cálculos fueron similares entre los grupos (p>0,05). Asimismo, las demás complicaciones clasificadas según la escala modificada de Clavien-Dindo fueron similares entre los grupos (p>0,05).ConclusiónLa punción guiada por ecografía (GE) proporciona niveles significativamente menores de descenso de hemoglobina y tiempo de exposición a la radiación en comparación con el procedimiento guiado por fluoroscopia (GF). (AU)

Introduction and objectives: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL).Material and methodsA total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared.ResultsA total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (P>.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7g/dL) when compared with US-assisted group (1.3g/dL) (P<.01). The mean duration of radiation exposure was significantly higher for the FG (P<.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (P>.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (P>.05).ConclusionUS-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG. (AU)

How does puncture modality affect the risk of intraoperative bleeding during percutaneous nephrolithotomy? A prospective randomized trial.

INTRODUCTION AND OBJECTIVES: To evaluate the possible effects of two different renal puncture techniques (ultrasound-assisted [US-assisted], fluoroscopic-guided [FG]) on the intraoperative hemorrhage risk during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: A total of 130 patients with Guy stone scores of 1-2 were prospectively allocated to US-assisted and FG puncture groups by simple randomization. Patients with intraoperative pelvicalyceal rupture and the ones requiring multiple accesses were excluded from the study. Apart from the puncture steps, all other steps of the PCNL procedure were performed with similar techniques by a single surgeon. Patient characteristics, operative data, and postoperative outcomes were compared. RESULTS: A total of 10 patients were excluded from the study due to intraoperative complications after puncture. Patient demographics and stone characteristics were similar between the two groups (p > 0.05). Mean hemoglobin drop was meaningfully greater in the FG group (1.7 g/dL) when compared with US-assisted group (1.3 g/dL) (p < 0.01). The mean duration of radiation exposure was significantly higher for the FG (p < 0.001). Total operative time, number of attempts for a successful puncture, length of hospital stay, and stone free rates were similar between the groups (p > 0.05). In addition, the remaining complications classified according to the modified Clavien-Dindo grading system were similar between groups (p > 0.05). CONCLUSION: US-assisted puncture provides significantly decreased level of hemoglobin drop and radiation exposure time when compared with FG.