DETECTION OF RESIDUAL FRAGMENTS DURING PERCUTANEOUS NEPHROLITHOTOMY: ROLE OF INTRA - OPERATIVE ULTRASOUND
| Autor: | Girish N, Ramalingaiah Ramalingaiah, Harshavardhan Harshavardhan, Rajanna B, Manjunath C S |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Kidney Stone clearance medicine.diagnostic_test business.industry Stone free medicine.medical_treatment Ultrasound urologic and male genital diseases Residual medicine.anatomical_structure Intra operative ultrasound medicine Fluoroscopy Radiology business Percutaneous nephrolithotomy |
| Zdroj: | Journal of Evolution of Medical and Dental Sciences. 3:14006-14012 |
| ISSN: | 2278-4802 2278-4748 |
| DOI: | 10.14260/jemds/2014/3874 |
| Popis: | AIMS: To prospectively evaluate the efficacy of ultrasound and fluoroscopy for detection residual stones during percutaneous nephrolithotomy (PCNL). MATERIAL AND METHODS: We prospectively evaluated 49 patients (55 renal units) undergoing percutaneous nephrolithotomy for renal calculi greater than2cms, in 38 renal units or staghorn calculus in 17 renal units, from May 2011 to Sep 2011. In 35 renal units patients underwent standard fluoroscopic guided PCNL and in 20 renal units patients underwent standard fluoroscopic guided PCNL followed by ultrasound of kidney was done before concluding the procedure. The size and location of residual fragments determined fluoroscopically and identified by ultrasound were compared. RESULTS: Stone free status was achieved in 27 of the 35 renal units using fluoroscopy alone, of the 27 renal units significant residual fragment were detected postoperatively by CT kidney in 8 false negative rate of 29.6% renal units, 4(14.8%) of them required ESWL/ relook PCNL. Clinically insignificant residual fragments (≤4mm) not observed in 4 (14.8%) renal units by fluoroscopy were confirmed by post-operative CT scan. Stone free status was achieved in 14 of the 20 renal units and stone clearance was ensured by intra- operative ultrasound alone. Clinically significant residual stones were detected in 3 (21%) of 14 renal units by post-operative CT, managed conservatively. Clinically insignificant residual fragments (≤4mm) observed in 3 (21%) patients which were confirmed by post-operative CT scan. CONCLUSION: Routine intra-operative ultrasound after standard PCNL helps in detecting CIRF and significant residual calculi. There were significant false positive and false negative rate of detection of residual stones which can be overcome by further experience in use of intra-operative ultrasound. |
| Databáze: | OpenAIRE |
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