الفهرس 
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Abstract
Summary
This was prospective randomized interventional clinical study, that was performed in Urology department, faculty of Medicine at Beni-Suef university from August 2020 to July 2022.
The aim of the study was to evaluate the safety, efficacy, and feasibility of Ultrasound guided PCNL (US-PCNL) in the management of renal stones in comparison with the conventional X-ray guided PCNL (FL-PCNL). In order to reduce the hazards of radiation exposure to the medical staff and patients.
The results of our study showed that in addition to Zero radiation in the US-PCNL group, a successful puncture was attained in all cases in both groups with higher accuracy achieved in US-PCNL group as US provided real-time visualization of the needle with 2D planes, making the puncture safer and easier. Unlike fluoroscopy, as 24% of patients required a second attempt and 5% required a third attempt. (p-value <0.001) regardless of the degree of hydronephrosis. Confirming the results reported by Agarwall et al, Li et al, and Basiri et al.
Using the US guidance reduces the time needed for achieving renal puncture (22.45 ± 6.95 sec) compared to fluoroscopy that was (68.28 ± 56.76 sec) with (P-value <0.001).
For the complex and branched renal calculi where multiple access tracts were deemed necessary, Wei Zhu et al reported that establishing multiple percutaneous tracts was easier using fluoroscopy in the FL-PCNL than in theUS-PCNL alone (17.1%vs. 9.5%) with (P-value 0.003) denoting some difficulty using the US alone in this situation. Thus, it is preferable when making multiple tracts to use combined techniques.
The mean duration of access that was reported in our study was (3.92 ± 0.72 min) in the US-PCNL group and (4.03 ±0.77 min) in the FL-PCNL group (p-value 0.460).
There was no significant difference in the total operative time between both groups in our study as the mean operative time in the US-PCNL group was (61.47 ± 6.07 min) and (65.86 ±20.86 min) in the FL-PCNL group with a (P- value of 0.349).
In our study in the US-PCNL, there was zero exposure to fluoroscopy while in the FL-PCNL the mean time of radiation exposure was 6.38 min (range from 2 min to 16.34 min).
In our pilot study, we found that using the combined technique also reduces the time of radiation exposure for those who adopt both techniques, as it lessened the radiation time to (1 min to 1.9 min) with avg 1.43 min. While using fluoroscopy only the total radiation time was (2 min to 16.32 min) with mean 6.38 min.
Regarding postoperative outcome, the SFR was nearly similar with (p-value 0.336). Three cases in our study in the FL-PCNL group had bleeding that required blood transfusion post-operative, mean Hb change was 0.23g/dL and 0.55 g/dL in US-PCNL and FL-PCNL groups respectively which is clinically irrelevant despite statistical significance (p-value 0.007). Three patients experienced extravasation and were managed by jj stent placement in the FL- PCNL group and one patient experienced postoperative fever in the US- PCNL group. (p-value 0.114)
In conclusion, Ultrasound guidance is a reliable tool in the hands of experienced urologists in performing PCNL with less or even zero radiation. Still fluoroscopy is a must have tool that should be in standby especially in cases with morbid obesity.