SAN DIEGO, CA USA (UroToday.com) - The impact of radiation exposure, specifically during endourologic stone treatment, has become a pertinent and controversial topic.
Recent literature has highlighted the potential oncologic consequences of excessive diagnostic radiation exposure. Percutaneous nephrolithotomy (PCNL), in particular, can be associated with large amounts of radiation exposure. In light of this, a number of poster presentations have been focused on this topic.
Endoscopic-guided PCNL (ePCNL) is a relatively new approach to PCNL that may have advantages in terms of radiation exposure, compared to standard PCNL technique. The goal of this study, performed by Lantz and colleagues, was to determine the radiation exposure (fluoroscopy time (FT) and effective dose of radiation (EDR)) related to ePCNL and to compare it to the published literature for standard PCNL techniques.
They retrospectively reviewed all ePCNL procedures performed at their institution from Nov 2011 to Oct 2012. All cases were performed by a single surgeon using under-table, C-arm fluoroscopy. Total FT and radiation dosage for each case was recorded and the EDR was calculated using standard conversion tables.
They reviewed a total of 29 ePCNL cases. Mean stone size was 3.3 x 2.0 cm with 52% and 11% of stones being partial and complete staghorn calculi, respectively, in their cohort. Almost half (49%) of cases utilized an upper pole puncture, with 61% supracostal punctures; only one patient required 2 tracts. Mean FT was 4.2 ±3.6 min and mean EDR was 2.8 ±2.4 mSv. Stone-free rate was 82%, and 11% required ancillary procedures. Overall complication rate was 31%, with the majority (7/9) being Clavien-Dindo grade 1-2. Importantly, longer FT correlated with increased stone size (p=0.002) and the need for ancillary procedures (p=0.005) while higher EDR correlated with increased skin-to-stone distance (SSD; p=0.013). Higher BMI did not correlate with FT, EDR, or operative time.
The FT and EDR from this retrospective review compared favorably to radiation doses and fluoroscopy time for PCNL reported in the literature, with both lower radiation dose and FT.
In conclusion, this preliminary, single-center retrospective review demonstrates that the ePCNL technique may be associated with a reduction in radiation dosage when compared to standard PCNL techniques, with comparable stone-free and complication rates. Larger, prospective studies are needed to better evaluate the potential advantages of this technique with regard to radiation exposure and how this balances out with the potential increased cost and time.
Presented by Andrea Lantz, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA
Division of Urology, St. Michael’s Hospital, University of Toronto, Canada
Reported for UroToday.com by Michael Ordon, MD; UC Irvine Medical Center, Orange, CA USA