Mauro Campoleoni

Introduction: Antegrade sclerotherapy (Tauber) effectively treats varicocele. However, fluoroscopy exposes young males to ionizing radiation. We aimed to evaluate radiation exposure and surgical outcomes after the Tauber procedure. Materials and methods: We retrospectively analysed data from 251 patients. Dose area product (DAP) and fluoroscopy time were recorded. The effective dose was calculated with the PCXMC software. Descriptive statistics and linear regression tested the association between clinical predictors and radiation exposure. Results: Median (IQR) age and body mass index (BMI) were 14 (13–16) years and 20.1 (17.9–21.6) kg/m². Five (2.1%) patients developed clinical recurrence and two (0.81%) developed complications. Median fluoroscopy time and DAP were 38.5 (27.7–54.0) s and 89.6 (62.5–143.9) cGy*cm². The effective dose was 0.19 (0.14–0.31) mSv. Fluoroscopy time was higher in patients with collateral veins (41 (26–49) s vs. 36 (31–61) s, p = 0.02). The median amount of sclerosing agent (SA) used was 3 (3–4) ml. DAP was higher when SA > 3 mL was used (101.4 (65–183) cGy*cm² vs. 80.5 (59–119) cGy*cm²; p < 0.01). At univariable linear regression, age, BMI, operative time and SA > 3 mL were associated with higher DAP (all p < 0.01). At multivariable linear regression, only BMI (beta 12.9, p < 0.001) and operative time (beta 1.9, p < 0.01) emerged as predictors of higher DAP, after accounting for age and SA > 3 mL. Conclusions: The Tauber procedure is safe and associated with low effective doses. Operative time and the patient’s BMI independently predict a higher radiation dose.

Purpose: To compare outcomes of two different techniques in miniaturized percutaneous nephrolithotomy (PCNL): minimally invasive PCNL (MIP) with the vacuum-cleaner effect and vacuum-assisted mini-PCNL (vmPCNL). Materials and methods: Data from 104 (66.7%) patients who underwent vmPCNL and 52 (33.3%) patients submitted to MIP at a single tertiary-referral academic center between 01/2016 and 12/2019 were analysed. Patients’ demographics, peri and post-operative data were recorded, and propensity-score matching was performed. Descriptive statistics and linear regression models were used to identify variables associated with operative time (OT) and patient’s effective dose. Logistic regression analyses were used to identify factors associated with infectious complications and stone free (SF) status. Results: Patients’ demographics and stone characteristics were comparable between groups. vmPCNL was associated with shorter OT (p <0.001), fluoroscopy time and patient’s effective dose (4.2 vs. 7.9 mSv; p<0.001). A higher rate of infectious complications was found in the MIP group (25.0% vs. 7.7%, p<0.01). Linear regression analysis showed that stone volume, multiple stone number and MIP procedure (all p≤0.02) were associated with longer OT. Similarly, OT and the MIP procedure (p≤0.02) were associated with higher patient’s effective dose. Logistic regression analysis revealed that stone volume, preoperative positive bladder urine culture and the MIP procedure (all p≤0.02) were associated with postoperative infectious complications. vmPCNL was not associated with SF rate. Conclusions: MiniPCNL performed with a continuous active suction is associated with lower rates of infectious complications, shorter OT and lower patient’s effective dose than MIP.

BACKGROUND AND PURPOSE: Cross-sectional imaging of the temporal bone is challenging because of the complexity and small dimensions of the anatomic structures. We evaluated the role of flat panel angiography in the cross-sectional imaging of the temporal bone by comparing its image quality and radiation dose with a 64-section multisection CT scanner. MATERIALS AND METHODS: We retrospectively collected 29 multisection CT and 29 flat panel angiography images of normal whole-head temporal bones. Image quality was assessed by 2 neuroradiologists, who rated the visualization of 30 anatomic structures with a 3-point ordinal scale. The radiation dose was assessed with an anthropomorphic phantom. RESULTS: Flat panel angiography showed better image quality than multisection CT in depicting the anterior and posterior crura of the stapes, the footplate of the stapes, the stapedius muscle, and the anterior ligament of the malleus (P < .05). In contrast, multisection CT showed better image quality than flat panel angiography in assessing the tympanic membrane, the bone marrow of the malleus and incus, the tendon of the tensor tympani, the interscalar septum, and the modiolus of the cochlea (P < .05). Flat panel angiography had a significantly higher overall image quality rating than multisection CT (P = .035). A reduction of the effective dose of approximately 40% was demonstrated for flat panel angiography compared with multisection CT. CONCLUSIONS: Flat panel angiography shows strengths and weaknesses compared with multisection CT. It is more susceptible to artifacts, but due to the higher spatial resolution, it shows equal or higher image quality in assessing some bony structures of diagnostic interest. The lower radiation dose is an additional advantage of flat panel angiography.