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Doppler-Guided PCNL Accurate and Safe

The study showed less blood loss compared to B-mode ultrasound

A study published recently in Urology found that Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) was safe, accurate, and resulted in less blood loss than B-mode ultrasound.

Although they are the two most commonly used methods of guidance for PCNL, fluoroscopy and B-mode ultrasonography both have important drawbacks. Fluoroscopy exposes patients to x rays. B-mode ultrasonography avoids x ray exposure, but it has its own challenges, such as complications from blood loss and nephrectomy. Power Doppler ultrasound may result in less bleeding from renal vascular injury because it can visualize blood vessels that B-mode ultrasound cannot. The authors undertook the current randomized trial to evaluate the role, safety, and effectiveness of Doppler ultrasound-guided PCNL and whether it could decrease the need for analgesia, related complications, and recovery.

A total of 131 patients were enrolled between March 2007 and February 2010. Inclusion criteria were adult patients scheduled for PCNL for huge (more than 35 mm) renal stones or stag horn stones. Exclusion criteria included history of ipsilateral renal surgery, bilateral stones, urosepsis, or a single kidney, if more than one tract or a supracostal approach was required. Patients were randomized into a B-mode ultrasound group (54 patients) or a Doppler ultrasound-guided group (57 patients). The authors found no differences between the two groups with regard to pre- or post-operative serum creatinine change, length of stay, return to normal activity, Clavien grade, relative perfusion rate, or glomerular filtration rate. Hemoglobin decrease was greater in the B-mode ultrasound-guided group compared to the Doppler ultrasound-guided group. The authors conclude that based on the results of the current study, "we believe color Doppler ultrasound guidance can be an important alternative to B-mode guidance for percutaneous renal procedures, especially for patients at greater risk of morbidity from hemorrhage and its associated complications."

Source: Tzeng B-C, Wang C-J, Huang S-W, Chang C-H. 2011. Doppler ultrasound-guided percutaneous nephrolithotomy: a prospective randomized study. Urology 58:535-539.