[Totally ultrasound guided percutaneous nephrolithotomy: An efficient and safe technique].

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Abstract
Percutaneous nephrolithotomy (PCNL) is the treatment for large and complex renal stones. Fluoroscopic guidance is the most used imaging method; however, radiation exposure is a significant concern. Recent studies have shown that ultrasound-guided PCNL is also feasible. To evaluate the safety of the two-step tract dilation technique using ultrasound guidance to avoid radiation exposure. Retrospective evaluation of data of patients treated between February 2019 and January 2023. Two groups were included based on tract dilation: Group 1 (G1): two-step totally ultrasound-guided dilation, and group 2 (G2): fluoroscopy-guided dilation. 100 patients were included, 50 in each group. Body mass index (31.7 vs. 28.7kg/m²; p = 0.002) and stone burden (10,935.69 vs. 5,460.86mm³; p = 0.006) were higher in G1; fluoroscopy was absent in the same group (0 vs. 29.4 sec; p < 0.005). Complications occurred in 13 patients in G1 and in 7 in G2 (p = 0.32); no complications grade 3b, 4 or 5 were observed in either group. The overall stone-free rate was 76% (74% vs. 78%; p = 0.81). Ultrasound-guided PCNL is a safe technique that avoids radiation exposure without compromising clinical outcomes.

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