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Urology. 2016 Dec;98:32-38. doi: 10.1016/j.urology.2016.04.012. Epub 2016 Apr 22.

Ultrasound Guidance to Assist Percutaneous Nephrolithotomy Reduces Radiation Exposure in Obese Patients.

Author information

1
Department of Urology, University of California, San Francisco, San Francisco, CA; Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand.
2
Department of Urology, University of California, San Francisco, San Francisco, CA.
3
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.
4
Department of Urology, University of California, San Francisco, San Francisco, CA. Electronic address: Tom.Chi@ucsf.edu.

Abstract

OBJECTIVE:

To evaluate the impact of body mass index (BMI) on perioperative outcomes and radiation exposure for ultrasound (US)-guided percutaneous nephrolithotomy (PCNL).

PATIENTS AND METHODS:

Data were prospectively collected for consecutive patients who underwent PCNL at the University of California, San Francisco, from July 2013 to November 2015. Patients were divided into 3 groups according to their BMI: <25 (normal weight), 25-29.9 (overweight), and >30 (obese) kg/m2. Perioperative outcomes were compared between patients who underwent US-guided vs fluoroscopy-guided PCNL.

RESULTS:

One hundred thirty-five patients were enrolled; 93 cases were performed under US and 42 under fluoroscopic guidance. US successfully guided renal access in 76.9% of normal weight, 79.0% of overweight, and 45.7% of obese patients (P < .05). Mean fluoroscopic screening time and radiation exposure dose were reduced for US compared to fluoroscopy cases across all BMI categories (P < .05). As BMI increased, radiation exposure dose rose disproportionately faster compared to screening time (P < .001). No significant differences among the BMI groups were found with regard to complication rate, hospital stay, and stone-free status.

CONCLUSION:

US-guided PCNL may be more difficult in obese patients, but with its use, the overweight and obese experience the largest absolute reduction in radiation exposure. Because these patients are inherently at greater risk for radiation exposure compared to normal weight patients, they may benefit the most from adoption of US for PCNL.

PMID:
27112513
PMCID:
PMC5648533
DOI:
10.1016/j.urology.2016.04.012
[Indexed for MEDLINE]
Free PMC Article

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